Individual
MS. LISA MARIE RANDOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
7540 N 19TH AVE STE 200, PHOENIX, AZ 85021-7967
(888) 873-4221
(888) 873-4221
Mailing address
2039 PACIFIC AVE, KINGMAN, AZ 86401-4136
(616) 307-3497
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4365
AZ
Other
Enumeration date
05/27/2009
Last updated
05/27/2009
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