Provider Demographics
NPI:1912788662
Name:TEED, RANDI LEE
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:LEE
Last Name:TEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6854 IRISH HILL RD
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18818-7751
Mailing Address - Country:US
Mailing Address - Phone:570-699-9611
Mailing Address - Fax:
Practice Address - Street 1:1 BELLA VISTA DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5792
Practice Address - Country:US
Practice Address - Phone:607-375-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017838225X00000X
NY025879-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist