Susan Randall

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057.005744 Issued in IL

Practice address

620 W Bridgeport St
White Hall, IL 62092-1001

Phone

(217) 374-2144

NPI assigned

Jun 22, 2023

Last updated

Jun 22, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1922784347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1076 NE 475 AVE",
            "city": "WHITE HALL",
            "state": "IL",
            "postal_code": "620924024",
            "telephone_number": "618-946-9332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W BRIDGEPORT ST",
            "city": "WHITE HALL",
            "state": "IL",
            "postal_code": "620921001",
            "telephone_number": "217-374-2144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4560 SE International Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "Milwaukie",
            "state": "OR",
            "postal_code": "972224628",
            "country_code": "US",
            "telephone_number": "971-206-2099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "SUSAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-22",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.005744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenn Killion, PT
• MP Sales (Extra Green Healthy Living)
• North Green Unit School Dist 3
• Pamida Stores Operating Co LLC (Pamida Pharmacy #683)
• Pharmacy Plus, Inc.
• White Hall Nursing and Rehabilitation Center, LLC
• Daniel Francis Woodlock, DDS

• Occupational Therapy Assistant in White Hall, IL
• Providers in White Hall, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.