Provider Demographics
NPI:1699847566
Name:FISCHER, RANDALL J (COTA,ATP)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:J
Last Name:FISCHER
Suffix:
Gender:M
Credentials:COTA,ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 BEECHWOODS RD
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723-6605
Mailing Address - Country:US
Mailing Address - Phone:845-798-7031
Mailing Address - Fax:
Practice Address - Street 1:606 OLD ROUTE 17
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-7013
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003421-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist