=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720137698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND ANDY SPEELMAN CP BOCP COF
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 638 ROSTRAVER RD SUITE 102
-----------------------------------------------------
City | BELLE VERNON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15012-1967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-350-0458
-----------------------------------------------------
Fax | 724-930-8545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 638 ROSTRAVER RD SUITE 102
-----------------------------------------------------
City | BELLE VERNON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15012-1967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-350-0458
-----------------------------------------------------
Fax | 724-930-8545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | ABC CP003203
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | BOC C16482
-----------------------------------------------------
License Number State |
-----------------------------------------------------