Provider Demographics
NPI:1720137698
Name:SPEELMAN, RAYMOND ANDY (CP BOCP COF)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ANDY
Last Name:SPEELMAN
Suffix:
Gender:M
Credentials:CP BOCP COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:638 ROSTRAVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-1967
Mailing Address - Country:US
Mailing Address - Phone:724-350-0458
Mailing Address - Fax:724-930-8545
Practice Address - Street 1:638 ROSTRAVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1967
Practice Address - Country:US
Practice Address - Phone:724-350-0458
Practice Address - Fax:724-930-8545
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ABC CP003203224P00000X
BOC C16482224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist