Susan Randall
Individual provider Active NPI Occupational Therapy Assistant · White Hall, IL
NPI 1922784347 · NPPES record last updated Jun 22, 2023
Key facts
- NPI
- 1922784347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 057.005744 (IL)
- Practice address
- 620 W Bridgeport St
White Hall, IL 62092-1001 - Phone
- (217) 374-2144
- NPI assigned
- Jun 22, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057.005744 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057.005744 | IL | Yes |
Addresses
Primary practice location
620 W Bridgeport St
White Hall, IL 62092-1001
Mailing address
1076 NE 475 Ave
White Hall, IL 62092-4024
Phone (618) 946-9332
Other practice location 1
4560 SE International Way Ste 100
Milwaukie, OR 97222-4628
Phone (971) 206-2099
Other providers in White Hall, IL
- Brenn Killion
- MP Sales
- North Green Unit School Dist 3
- Pamida Stores Operating Co LLC
- Pharmacy Plus, Inc.
- White Hall Nursing and Rehabilitation Center, LLC
- Daniel Francis Woodlock
All providers in White Hall, IL · Occupational Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.