Provider Demographics
NPI:1598105488
Name:CARR, RANDI ARLENE
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:ARLENE
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42262-4210
Mailing Address - Country:US
Mailing Address - Phone:931-206-6229
Mailing Address - Fax:
Practice Address - Street 1:304 WILSON DR
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:KY
Practice Address - Zip Code:42262-4210
Practice Address - Country:US
Practice Address - Phone:931-206-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist