Individual
RANDALL J AMMONDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
4502 NW SCENIC DR, PEORIA, IL 61615-3756
(309) 682-3743
Mailing address
4502 NW SCENIC DR, PEORIA, IL 61615-3756
(309) 682-3743
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.005495
IL
Other
Enumeration date
01/19/2010
Last updated
01/19/2010
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