NPIMap

Organization Active NPI

Functional Freedom LLC

  • Occupational Therapist
  • Lancaster, PA
National Provider Identifier
1861989493
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OC012565 Issued in PA
Legal business name
FUNCTIONAL FREEDOM LLC
Practice address
105 Heritage Rd.
Lancaster, PA 17602
Phone
(717) 572-7966
NPI assigned
Apr 19, 2018
Last updated
Nov 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Authorized official

Name
Mrs. Kourtney Randsdorp, OTR/LNPI 1710221668
Title
Occupational Therapist
Phone
(717) 572-7966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OC013759 PA
Occupational Therapist 225X00000X OC012565 PA Primary

Addresses

Primary practice location

105 Heritage Rd.
Lancaster, PA 17602

Mailing address

105 Heritage Rd.
Lancaster, PA 17602
Phone (717) 572-7966

Other practice location 1

703 Lampeter Rd Rm 5
Lancaster, PA 17602-4013
Phone (717) 663-8307

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180802002594 PA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6406104728 Receives reassigned benefits from 11 practitioners
Practice locations: Lancaster, PA

National Provider Directory

National Provider Directory

Locations

703 Lampeter Rd
Rm 5
Lancaster, PA 17602
Phone (717) 663-8307

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1861989493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 HERITAGE RD.",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "17602",
            "telephone_number": "717-572-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HERITAGE RD.",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "17602",
            "telephone_number": "717-572-7966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "703 Lampeter Rd Rm 5",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176024013",
            "country_code": "US",
            "telephone_number": "717-663-8307",
            "fax_number": "717-823-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FUNCTIONAL FREEDOM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-19",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "RANDSDORP",
        "authorized_official_first_name": "KOURTNEY",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "717-572-7966",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC013759",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC012565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.