Provider Demographics
NPI:1164548285
Name:HUGHES, BRANDI J (OT)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:J
Last Name:HUGHES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:217-344-8047
Practice Address - Street 1:1802 S. MATTIS AVE.
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5923
Practice Address - Country:US
Practice Address - Phone:217-893-7720
Practice Address - Fax:309-664-3422
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7216OtherPERSONALCARE PROV ID
IL203OtherBLUE CROSS PROV ID
IL4117OtherHAMP PROV ID
113326OtherHEALTHLINK PROV ID
140091Medicare ID - Type Unspecified