Provider Demographics
NPI:1922267715
Name:RANDALL, VALERIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:RANDALL
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:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98385-0257
Mailing Address - Country:US
Mailing Address - Phone:360-897-9505
Mailing Address - Fax:
Practice Address - Street 1:2323 JENSEN ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3605
Practice Address - Country:US
Practice Address - Phone:360-825-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist