Provider Demographics
NPI:1598803785
Name:SPEELMAN, ELMER J (CPO)
Entity type:Individual
Prefix:MR
First Name:ELMER
Middle Name:J
Last Name:SPEELMAN
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 1:435 W RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5576
Mailing Address - Country:US
Mailing Address - Phone:910-286-6306
Mailing Address - Fax:910-483-9622
Practice Address - Street 1:435 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5576
Practice Address - Country:US
Practice Address - Phone:910-286-6306
Practice Address - Fax:910-483-9622
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7795083222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000024Medicaid
NC7795083Medicaid