Individual
CRYSTAL DOMINIQUE RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
134 INFIELD CT, MOORESVILLE, NC 28117-8026
(704) 799-6824
(704) 799-6825
Mailing address
134 INFIELD CT, MOORESVILLE, NC 28117-8026
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11941
NC
Other
Enumeration date
09/30/2022
Last updated
04/16/2024
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