Provider Demographics
NPI:1689929739
Name:GIMENEZ, RANDEE A (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:RANDEE
Middle Name:A
Last Name:GIMENEZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 FERN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2547
Mailing Address - Country:US
Mailing Address - Phone:804-306-4958
Mailing Address - Fax:
Practice Address - Street 1:7706 FERN HOLLOW DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2547
Practice Address - Country:US
Practice Address - Phone:804-306-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004844225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist