Provider Demographics
NPI:1467584110
Name:ANDERSON, RANDI LAINE (OTR)
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:LAINE
Last Name:ANDERSON
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 1:2800 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5318
Mailing Address - Country:US
Mailing Address - Phone:202-387-4434
Mailing Address - Fax:202-797-8220
Practice Address - Street 1:2800 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5318
Practice Address - Country:US
Practice Address - Phone:202-387-4434
Practice Address - Fax:202-797-8220
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist