Provider Demographics
NPI:1326231200
Name:MCCLUSKY OCASIO, BREE ANN (DPT, PT)
Entity Type:Individual
Prefix:MS
First Name:BREE
Middle Name:ANN
Last Name:MCCLUSKY OCASIO
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:BREE
Other - Middle Name:ANN
Other - Last Name:MCCLUSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2110 FOX DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7596
Mailing Address - Country:US
Mailing Address - Phone:217-366-1323
Mailing Address - Fax:
Practice Address - Street 1:2110 FOX DR STE B
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7596
Practice Address - Country:US
Practice Address - Phone:217-366-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70015763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203OtherBLUE CROSS PROVIDER ID
IL7216OtherPERSONALCARE PROVIDER ID
IL113326OtherHEALTHLINK
IL4117OtherHAMP PROVIDER ID
IL113326OtherHEALTHLINK