Individual
ALEXANDRIA MARIE RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
105 LEXINGTON DR STE H, MADISON, MS 39110-6646
(601) 910-7300
(601) 910-7071
Mailing address
100 TRACEY CV, MADISON, MS 39110-6045
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3515
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT3515
MISSISSIPI DEPARTMENT OF LICENSURE
MS
Enumeration date
01/09/2020
Last updated
08/24/2022
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