Provider Demographics
NPI:1851696017
Name:RANDALL, BETH SZYMONIAK (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:SZYMONIAK
Last Name:RANDALL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 WEBSTER ST
Mailing Address - Street 2:C/O DAVIS ELEMENTARY SCHOOL
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-2226
Mailing Address - Country:US
Mailing Address - Phone:518-483-7802
Mailing Address - Fax:
Practice Address - Street 1:183 WEBSTER ST
Practice Address - Street 2:C/O DAVIS ELEMENTARY SCHOOL
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2226
Practice Address - Country:US
Practice Address - Phone:518-483-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011968225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics