Brandi Broaddus, COTA/L
Occupational Therapy Assistant in Springfield, IL. Individual provider (NPI-1).
NPI number1922763515
StatusActive
Last updated in NPPESNov 8, 2021
Details
- NPI
- 1922763515
- Entity type
- Individual (NPI-1)
- Name
- Brandi Broaddus
- Credential
- COTA/L
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Nov 8, 2021
- Certification date
- Nov 8, 2021
- Last updated
- Nov 8, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 224Z00000X | Occupational Therapy Assistant | 057005546 | IL | Yes |
Practice location
3131 Greenhead Dr Ste DSpringfield, IL 62711-7426
Phone 217-891-1524
Mailing address
3 Molly DrGirard, IL 62640-9580
Phone 217-652-4021
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Occupational Therapy Assistant providers in Springfield, IL
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All 33 Occupational Therapy Assistant providers in Springfield · All 5,952 providers in Springfield
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