Brandi Broaddus, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057005546 Issued in IL

Practice address

3131 Greenhead Dr Ste D
Springfield, IL 62711-7426

Phone

(217) 891-1524

NPI assigned

Nov 8, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1922763515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MOLLY DR",
            "city": "GIRARD",
            "state": "IL",
            "postal_code": "626409580",
            "telephone_number": "217-652-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 GREENHEAD DR STE D",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627117426",
            "telephone_number": "217-891-1524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADDUS",
        "first_name": "BRANDI",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057005546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COTA",
            "identifier": "057005546",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John L Briggs, DO
• Madeleine Elizabeth Brindle, MD
• Susan Elizabeth Brinkoetter, CCC-SLP
• Rodica S Brisan, M.D.
• Tiffany Nicole Britt
• Katherine G Brockhouse, FNP-BC
• Nichole Brockmeyer
• Catherine Anne Brodehl, PSYD, LCPC
• Pamela S. Brodt, ACNP-BC
• Audrey E Brohammer, OTR

• Occupational Therapy Assistant in Springfield, IL
• Providers in Springfield, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.