Provider Demographics
NPI:1073170254
Name:SOBODAS, BRIANNE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:
Last Name:SOBODAS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22939 S KATHEY DR
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3239
Mailing Address - Country:US
Mailing Address - Phone:815-600-0687
Mailing Address - Fax:
Practice Address - Street 1:2132 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6622
Practice Address - Country:US
Practice Address - Phone:815-741-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist