Provider Demographics
NPI:1831379668
Name:SPEICHER, KAREN J (OT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:SPEICHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CENTRAL IOWA DR
Mailing Address - Street 2:SUITE 70
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:50158-5983
Mailing Address - Country:US
Mailing Address - Phone:641-754-6120
Mailing Address - Fax:641-754-6154
Practice Address - Street 1:55 CENTRAL IOWA DR
Practice Address - Street 2:SUITE 70
Practice Address - City:MARSHALLTOWN
Practice Address - State:IL
Practice Address - Zip Code:50158-5983
Practice Address - Country:US
Practice Address - Phone:641-754-6120
Practice Address - Fax:641-754-6154
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103525225X00000X
WI5278-26225X00000X
IL056.010006225X00000X
IA077333225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB3481004Medicare PIN
IAI19172082Medicare PIN
IAI19172Medicare PIN
IAIB3481Medicare PIN