Individual
MRS. THERESA MAJELLA RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
15 BONNIEVIEW ST, NORTH SALEM, NY 10560-1307
(845) 363-6630
Mailing address
15 BONNIEVIEW ST, NORTH SALEM, NY 10560-1307
(845) 363-6630
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
016402
NY
Other
Enumeration date
10/04/2011
Last updated
12/21/2011
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