Provider Demographics
NPI:1245352301
Name:DEAN, BRENDA DIANNE (OT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DIANNE
Last Name:DEAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:DIANNE
Other - Last Name:SHERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7090 WAGNER HILL RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7726
Mailing Address - Country:US
Mailing Address - Phone:607-377-2002
Mailing Address - Fax:
Practice Address - Street 1:1 ARC WAY
Practice Address - Street 2:ARC OF STEUBEN
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-8341
Practice Address - Country:US
Practice Address - Phone:607-622-1877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009451-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist