Provider Demographics
NPI:1912329319
Name:MARSHALL, RANDALL DOUGLAS (OT)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:DOUGLAS
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:OT
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 21146
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1146
Mailing Address - Country:US
Mailing Address - Phone:254-202-9800
Mailing Address - Fax:254-202-9849
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8954
Practice Address - Country:US
Practice Address - Phone:254-202-9800
Practice Address - Fax:254-202-9849
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107868225XH1200X
IDOT-1283225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand