Individual
BRANDI BROADDUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3131 GREENHEAD DR STE D, SPRINGFIELD, IL 62711-7426
(217) 891-1524
Mailing address
3 MOLLY DR, GIRARD, IL 62640-9580
(217) 652-4021
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005546
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057005546
COTA
IL
Enumeration date
11/08/2021
Last updated
11/08/2021
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