Active NPI
Randall Thomas Wesley
- Occupational Therapist
- Chicago, IL
National Provider Identifier
1326332610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- APPLIED FOR
- Practice address
- 820 S Damen Ave
Chicago, IL 60612-3728 - Phone
- (312) 569-8387
- NPI assigned
- Jun 3, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | APPLIED FOR | IL | Primary |
Addresses
Primary practice location
820 S Damen Ave
Chicago, IL 60612-3728
Mailing address
10409 S Troy St
Chicago, IL 60655-2023
Phone (773) 807-2015
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APPLIED FOR | IL | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307059200000",
"number": "1326332610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10409 S TROY ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606552023",
"telephone_number": "773-807-2015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 S DAMEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123728",
"telephone_number": "312-569-8387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WESLEY",
"first_name": "RANDALL",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-03",
"last_updated": "2011-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "APPLIED FOR",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.