Individual
BETHANY DANIELLE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
873 GROVE ST, JACKSONVILLE, IL 62650-2828
(217) 479-3400
Mailing address
1076 NE 475 AVE, WHITE HALL, IL 62092-4024
(618) 946-9219
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005812
IL
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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