Provider Demographics
NPI:1346363157
Name:FARRELL, RANDI (OTR)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21907 GRAND CREEK CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5515
Mailing Address - Country:US
Mailing Address - Phone:281-647-6025
Mailing Address - Fax:
Practice Address - Street 1:21907 GRAND CREEK CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5515
Practice Address - Country:US
Practice Address - Phone:281-647-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012184OtherOT LICENSURE NUMBER