Active NPI
Randrea Donaldson, OTA
- Occupational Therapy Assistant
- Valdosta, GA
National Provider Identifier
1649664012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA001863
- Practice address
- 202 W Park Ave
Valdosta, GA 31602-2507 - Phone
- (229) 253-8500
- Fax
- (229) 253-8522
- NPI assigned
- Mar 24, 2015
- 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 Therapy Assistant | 224Z00000X | OTA001863 | GA | Primary |
Addresses
Primary practice location
202 W Park Ave
Valdosta, GA 31602-2507
Mailing address
202 W Park Ave
Valdosta, GA 31602-2507
Phone (229) 253-8500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OTA001863 | Other | GA | GEORGIA SECRETARY OF STATE |
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 |
|---|---|---|---|
| OTA001863 | GA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427155200000",
"number": "1649664012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 W PARK AVE",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316022507",
"telephone_number": "229-253-8500",
"fax_number": "229-253-8522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 W PARK AVE",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316022507",
"telephone_number": "229-253-8500",
"fax_number": "229-253-8522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONALDSON",
"first_name": "RANDREA",
"credential": "OTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-24",
"last_updated": "2015-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "GA",
"license": "OTA001863",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA SECRETARY OF STATE",
"identifier": "OTA001863",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.