Individual
SUSAN RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
620 W BRIDGEPORT ST, WHITE HALL, IL 62092-1001
(217) 374-2144
Mailing address
1076 NE 475 AVE, WHITE HALL, IL 62092-4024
(618) 946-9332
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005744
IL
Other
Enumeration date
06/22/2023
Last updated
06/22/2023
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