Provider Demographics
NPI:1578049243
Name:LIM, RANDALL M
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:M
Last Name:LIM
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 1:23934 BEARBERRY THICKET TRL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-5064
Mailing Address - Country:US
Mailing Address - Phone:281-636-8745
Mailing Address - Fax:
Practice Address - Street 1:23934 BEARBERRY THICKET TRL
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-5064
Practice Address - Country:US
Practice Address - Phone:281-636-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist