Individual
MELISSA CAROL RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
13940 N US HIGHWAY 441, LADY LAKE, FL 32159-8908
(352) 750-1095
(352) 750-1096
Mailing address
8835 SE 158TH ST, SUMMERFIELD, FL 34491-9629
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA11420
FL
Other
Enumeration date
11/15/2010
Last updated
07/18/2014
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