Individual
MRS. STEPHANIE MARIE RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1100 CLUB VILLAGE DR, SUITE 103, COLUMBIA, MO 65203-4409
(573) 256-2777
Mailing address
1100 CLUB VILLAGE DRIVE, SUITE 103, COLUMBIA, MO 65203-9917
(573) 256-2777
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2011001219
MO
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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