Provider Demographics
NPI:1669946893
Name:BRANAN, DAWN MICHELLE (OT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:BRANAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MICHELLE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 AVIGNON DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5120
Mailing Address - Country:US
Mailing Address - Phone:601-605-6777
Mailing Address - Fax:601-607-1362
Practice Address - Street 1:103 FOX CHASE DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2575
Practice Address - Country:US
Practice Address - Phone:601-264-8828
Practice Address - Fax:601-607-1377
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist