Provider Demographics
NPI:1528494903
Name:HERTEL, BRANDI (OTR/L)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:
Last Name:HERTEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1837
Mailing Address - Country:US
Mailing Address - Phone:217-493-9539
Mailing Address - Fax:
Practice Address - Street 1:3405 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1837
Practice Address - Country:US
Practice Address - Phone:217-493-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR440827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist