Provider Demographics
NPI:1578582862
Name:GOOTZEIT, RANDY J (MS, OTR/L, CHT)
Entity Type:Individual
Prefix:MS
First Name:RANDY
Middle Name:J
Last Name:GOOTZEIT
Suffix:
Gender:F
Credentials:MS, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 E CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1171
Mailing Address - Country:US
Mailing Address - Phone:602-228-9843
Mailing Address - Fax:
Practice Address - Street 1:1245 E CHOLLA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1171
Practice Address - Country:US
Practice Address - Phone:602-228-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3735225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand