Provider Demographics
NPI:1689132342
Name:QUICHO, ARVIN
Entity Type:Individual
Prefix:
First Name:ARVIN
Middle Name:
Last Name:QUICHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 E CAMELOT CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6917
Mailing Address - Country:US
Mailing Address - Phone:937-750-7504
Mailing Address - Fax:
Practice Address - Street 1:3911 E CAMELOT CIR APT 102
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6917
Practice Address - Country:US
Practice Address - Phone:937-750-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012787225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist