Provider Demographics
NPI:1487864047
Name:FINN, RANDY
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:FINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:06334 160TH STREET
Mailing Address - Street 2:PO BOX 450
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633-0450
Mailing Address - Country:US
Mailing Address - Phone:218-335-8110
Mailing Address - Fax:
Practice Address - Street 1:MAIN ROAD
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0427
Practice Address - Country:US
Practice Address - Phone:218-679-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist