Provider Demographics
NPI:1720609613
Name:KEICHINGER, RAYMOND PETER II (COTA/L)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PETER
Last Name:KEICHINGER
Suffix:II
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 N MOZART ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1739
Mailing Address - Country:US
Mailing Address - Phone:773-414-4428
Mailing Address - Fax:
Practice Address - Street 1:9300 W BALLARD RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4904
Practice Address - Country:US
Practice Address - Phone:847-294-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant