Individual
AMY RANDOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21160 MAPLE BRANCH TER, ASHBURN, VA 20147-6160
(571) 291-6192
Mailing address
21160 MAPLE BRANCH TER, ASHBURN, VA 20147-6160
(571) 291-6192
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119006684
VA
Other
Enumeration date
11/15/2016
Last updated
11/15/2016
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