Provider Demographics
NPI:1255318176
Name:DEVLIN, WILLIAM ROBERT (CPO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:DEVLIN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4220
Mailing Address - Country:US
Mailing Address - Phone:217-344-6664
Mailing Address - Fax:217-344-9282
Practice Address - Street 1:502 S VINE ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4220
Practice Address - Country:US
Practice Address - Phone:217-344-6664
Practice Address - Fax:217-344-9282
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL113686141001Medicaid
ILCPO02628OtherABC CERTIFICATION NUMBER
ILCPO02628OtherABC CERTIFICATION NUMBER