Provider Demographics
NPI:1306020466
Name:DEVEIKAS, CHARLES J JR (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:DEVEIKAS
Suffix:JR
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 RUTLAND ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2107
Mailing Address - Country:US
Mailing Address - Phone:617-306-5130
Mailing Address - Fax:617-393-0283
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:781-643-7000
Practice Address - Fax:617-393-0283
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4085225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6697630001Medicare NSC
MAY6923301Medicare PIN