Provider Demographics
NPI:1114363074
Name:TORBERT, RANDY MICHAEL (COTA)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:MICHAEL
Last Name:TORBERT
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 RIVER BEND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:AL
Mailing Address - Zip Code:35049-5839
Mailing Address - Country:US
Mailing Address - Phone:205-559-7120
Mailing Address - Fax:
Practice Address - Street 1:211 RIVER BEND RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:AL
Practice Address - Zip Code:35049-5839
Practice Address - Country:US
Practice Address - Phone:205-559-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2686224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant