Active NPI
Randi J. Carlson - Neideffer, OTR/L
- Occupational Therapist
- Goose Creek, SC
National Provider Identifier
1407991847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2990
- Practice address
- 104 Springfield PL
Goose Creek, SC 29445-5407 - Phone
- (843) 553-1665
- Fax
- (843) 766-3478
- NPI assigned
- Feb 21, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 2990 | SC | Primary |
Addresses
Primary practice location
104 Springfield PL
Goose Creek, SC 29445-5407
Mailing address
104 Springfield PL
Goose Creek, SC 29445-5407
Phone (843) 553-1665
Other names 1
- Randi Jean Neideffer
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2990 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492473600000",
"number": "1407991847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 SPRINGFIELD PL",
"city": "GOOSE CREEK",
"state": "SC",
"postal_code": "294455407",
"telephone_number": "843-553-1665",
"fax_number": "843-766-3478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 SPRINGFIELD PL",
"city": "GOOSE CREEK",
"state": "SC",
"postal_code": "294455407",
"telephone_number": "843-553-1665",
"fax_number": "843-766-3478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON - NEIDEFFER",
"first_name": "RANDI",
"middle_name": "J.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2017-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "2990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RANDI",
"last_name": "NEIDEFFER",
"middle_name": "JEAN",
"credential": "OTR/L",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Goose Creek, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.