Provider Demographics
NPI:1356890685
Name:RECIO, RAYMOND FELIMON FLANCIA
Entity type:Individual
Prefix:
First Name:RAYMOND FELIMON
Middle Name:FLANCIA
Last Name:RECIO
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 1:718 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6303
Mailing Address - Country:US
Mailing Address - Phone:240-825-7710
Mailing Address - Fax:
Practice Address - Street 1:25072 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-5039
Practice Address - Country:US
Practice Address - Phone:304-822-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07830225X00000X
WV1995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD321744OtherMEDICARE PTAN
MD437404500Medicaid