Provider Demographics
NPI:1578635264
Name:RANDLE, JULIA (OTRL)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:MERITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:7301 PEAK DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9038
Practice Address - Country:US
Practice Address - Phone:702-940-3000
Practice Address - Fax:702-940-3004
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6107697-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6767Medicaid