Provider Demographics
NPI:1295138196
Name:HARDING, RANDI (MSOTR/L)
Entity type:Individual
Prefix:MISS
First Name:RANDI
Middle Name:
Last Name:HARDING
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5861 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DEWITTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14728-9736
Mailing Address - Country:US
Mailing Address - Phone:716-581-1402
Mailing Address - Fax:
Practice Address - Street 1:25 CHATEAU TER
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3927
Practice Address - Country:US
Practice Address - Phone:716-839-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019133-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics