1164548285 NPI number — MS. BRANDI J HUGHES OT

Table of content: MS. BRANDI J HUGHES OT (NPI 1164548285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164548285 NPI number — MS. BRANDI J HUGHES OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGHES
Provider First Name:
BRANDI
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOODY
Provider Other First Name:
BRANDI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164548285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 W PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61801-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-383-6941
Provider Business Mailing Address Fax Number:
217-344-8047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1802 S. MATTIS AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMPAIGN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61821-5923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-893-7720
Provider Business Practice Location Address Fax Number:
309-664-3422
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  056007432 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7216 . This is a "PERSONALCARE PROV ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203 . This is a "BLUE CROSS PROV ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4117 . This is a "HAMP PROV ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 113326 . This is a "HEALTHLINK PROV ID" identifier . This identifiers is of the category "OTHER".




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