Provider Demographics
NPI:1639521818
Name:RANDLES, LAURALYN (COMS)
Entity Type:Individual
Prefix:MRS
First Name:LAURALYN
Middle Name:
Last Name:RANDLES
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1438
Mailing Address - Country:US
Mailing Address - Phone:815-325-2999
Mailing Address - Fax:
Practice Address - Street 1:228 ROBINSON DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1438
Practice Address - Country:US
Practice Address - Phone:815-325-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2477633OtherTEACHER OF THE VISUALLY IMPAIRED