Provider Demographics
NPI:1235464702
Name:RANDALL, BETSY DAVIS (MSOTR/L, CIMI)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:DAVIS
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MSOTR/L, CIMI
Other - Prefix:MISS
Other - First Name:BETSY
Other - Middle Name:MARIE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L, CIMI
Mailing Address - Street 1:PO BOX 1070
Mailing Address - Street 2:92 NORTHWOOD RD
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-5070
Mailing Address - Country:US
Mailing Address - Phone:207-239-7330
Mailing Address - Fax:
Practice Address - Street 1:92 NORTHWOOD RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-3625
Practice Address - Country:US
Practice Address - Phone:207-239-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017019-1225X00000X
CT003795225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist