Provider Demographics
NPI:1790410140
Name:PANKIEWICZ, RICHARD JOSEPH (OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:PANKIEWICZ
Suffix:
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 1:5156 WHITETAIL RIDGE LN.
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MO
Mailing Address - Zip Code:65619
Mailing Address - Country:US
Mailing Address - Phone:417-268-7281
Mailing Address - Fax:
Practice Address - Street 1:902 WEST BATTLEFIELD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-771-5515
Practice Address - Fax:417-771-5998
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XE1200X, 225XP0019X
1051100152225XH1200X
MO004196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation