Provider Demographics
NPI:1760631485
Name:VILLARREAL, RANDEE MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:RANDEE
Middle Name:MARIE
Last Name:VILLARREAL
Suffix:
Gender:F
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 1:2107 ROSALIE CT
Mailing Address - Street 2:
Mailing Address - City:HUGHSON
Mailing Address - State:CA
Mailing Address - Zip Code:95326-9599
Mailing Address - Country:US
Mailing Address - Phone:209-345-5313
Mailing Address - Fax:
Practice Address - Street 1:2107 ROSALIE CT
Practice Address - Street 2:
Practice Address - City:HUGHSON
Practice Address - State:CA
Practice Address - Zip Code:95326-9599
Practice Address - Country:US
Practice Address - Phone:209-345-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4081225X00000X
CA11641225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist