Provider Demographics
NPI:1659523645
Name:O'REILLY, BRANDI LEIGH (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:LEIGH
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 S. CAMPBELL
Mailing Address - Street 2:#N
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810
Mailing Address - Country:US
Mailing Address - Phone:417-576-8695
Mailing Address - Fax:
Practice Address - Street 1:4560 S CAMPBELL AVE
Practice Address - Street 2:SUITE # N
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1720
Practice Address - Country:US
Practice Address - Phone:417-576-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008025214174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist