Individual
MICHELLE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR-L
Contact information
Practice address
980 BOSQUE FARMS BLVD, BOSQUE FARMS, NM 87068-9652
(505) 554-0052
Mailing address
2325 STEVENS DR NE, ALBUQUERQUE, NM 87112-1449
(505) 321-8217
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396354981
—
NM
Enumeration date
02/21/2020
Last updated
11/14/2022
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