Individual
REBECCA RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7 MAVERICK ST, CHARLESTON, SC 29403-4114
(843) 882-7115
Mailing address
7 MAVERICK ST, CHARLESTON, SC 29403-4114
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
3976
SC
247200000X
Other Technician
CFTS3976
SC
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
11/08/2010
Last updated
11/08/2010
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