Donald Eugene Kallembach, OT
Individual provider Active NPI Occupational Therapist · Springfield, IL
NPI 1679912356 · NPPES record last updated Jun 17, 2013
Key facts
- NPI
- 1679912356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 056004959 (IL)
- Practice address
- 1224 W Laurel St
Springfield, IL 62704-3529 - Phone
- (314) 546-8840
- NPI assigned
- Jun 17, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250127000519 | NY | Practitioner - Occupational Therapist in Private Practice | 7315476959 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056004959 | IL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Affinity Rehabilitation LLP | Current |
Accepting new patients |
Locations
500 N Columbus Ave
Mount Vernon, NY 10552
Phone (914) 266-3796
1 Johnsarbor Dr W
Rochester, NY 14620
Phone (585) 532-7214
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056004959 | IL | Yes |
Addresses
Primary practice location
1224 W Laurel St
Springfield, IL 62704-3529
Mailing address
1224 W Laurel St
Springfield, IL 62704-3529
Phone (314) 546-8840
Other providers in Springfield, IL
- Seetal Kakumani
- Srinivasa Kakumani
- Vishal V Kalavadia
- Kaleidoscope Counseling
- Abubaker Kallan
- Constadina Emilia Kalouris
- Fnu Kalpana
- Kam Counseling PLLC
- Onsi W Kamel
- Gabrielle Kaminsky
All providers in Springfield, IL · Occupational Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.