Healthcare Provider Details

I. General information

NPI: 1356469571
Provider Name (Legal Business Name): DINA MARIE MILES BRESLIN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 EARLY PRIDE CT
PASADENA MD
21122-3845
US

IV. Provider business mailing address

320 EARLY PRIDE CT
PASADENA MD
21122-3845
US

V. Phone/Fax

Practice location:
  • Phone: 410-437-5367
  • Fax:
Mailing address:
  • Phone: 410-437-5367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number02475
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: