Provider Demographics
NPI:1003160979
Name:DENOOYER, RANDY LEE (BA CBIS)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:LEE
Last Name:DENOOYER
Suffix:
Gender:M
Credentials:BA CBIS
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Mailing Address - Street 1:3280 MICHAEL AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-2738
Mailing Address - Country:US
Mailing Address - Phone:616-531-9060
Mailing Address - Fax:616-531-0637
Practice Address - Street 1:3280 MICHAEL AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-2738
Practice Address - Country:US
Practice Address - Phone:616-531-9060
Practice Address - Fax:616-531-0637
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner