Active NPI
Kelly Ross Randall, MS,OTR/L, CLT
- Occupational Therapist
- George, IA
National Provider Identifier
1457551285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 01563
- Practice address
- 324 1St Ave N
George, IA 51237-1029 - Phone
- (712) 475-3391
- NPI assigned
- Jul 19, 2007
- 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 | 01563 | IA | Primary |
Addresses
Primary practice location
324 1St Ave N
George, IA 51237-1029
Mailing address
706 Eagle Run
Dell Rapids, SD 57022-2142
Phone (605) 428-5851
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01563 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184803200000",
"number": "1457551285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "706 EAGLE RUN",
"city": "DELL RAPIDS",
"state": "SD",
"postal_code": "570222142",
"telephone_number": "605-428-5851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 1ST AVE N",
"city": "GEORGE",
"state": "IA",
"postal_code": "512371029",
"telephone_number": "712-475-3391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "KELLY",
"middle_name": "ROSS",
"name_prefix": "Mr.",
"credential": "MS,OTR/L, CLT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-19",
"last_updated": "2007-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IA",
"license": "01563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in George, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.