Provider Demographics
NPI:1407068901
Name:WEBER, RANDI COLE (MA,OTR,L)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:COLE
Last Name:WEBER
Suffix:
Gender:F
Credentials:MA,OTR,L
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:C
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,OTR,L
Mailing Address - Street 1:180 MCAULAY PLACE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651
Mailing Address - Country:US
Mailing Address - Phone:949-494-9332
Mailing Address - Fax:
Practice Address - Street 1:1700 ADAMS AVE 103
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-556-2288
Practice Address - Fax:714-435-1745
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist