Bethany Danielle Randall, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057.005812 Issued in IL

Practice address

873 Grove St
Jacksonville, IL 62650-2828

Phone

(217) 479-3400

NPI assigned

Jul 12, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1114651452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1076 NE 475 AVE",
            "city": "WHITE HALL",
            "state": "IL",
            "postal_code": "620924024",
            "telephone_number": "618-946-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "873 GROVE ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502828",
            "telephone_number": "217-479-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "BETHANY",
        "middle_name": "DANIELLE",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-12",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.005812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Rose Prevett
• Rebecca Beth Pritikin, M.ED, LAT, ATC
• R & D Pharmacies, Inc
• Constance Racine Radford, MSOT
• Tara Jean Ramsey, M.D.
• Alexander David Raw, MD
• Lynne N Redick
• Reese Family Chiropractic Service Corporation
• Douglas K Reese, DC
• Regional Orthopaedics & Sports Medicine Center, LTD.

• Occupational Therapy Assistant in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.