Provider Demographics
NPI:1801165394
Name:WOLK, RANDI (MA,OTR/L)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:WOLK
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 CHAPPELL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3215
Mailing Address - Country:US
Mailing Address - Phone:919-832-3909
Mailing Address - Fax:919-832-3035
Practice Address - Street 1:739 CHAPPELL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3215
Practice Address - Country:US
Practice Address - Phone:919-832-3909
Practice Address - Fax:919-832-3035
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4166225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics