Provider Demographics
NPI:1285869735
Name:RANDALL, YVONNE MICHIELLE (OTR/L)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:MICHIELLE
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 1:6576 APPLETREE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4325
Mailing Address - Country:US
Mailing Address - Phone:702-280-0236
Mailing Address - Fax:702-368-2220
Practice Address - Street 1:6576 APPLETREE CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4325
Practice Address - Country:US
Practice Address - Phone:702-280-0236
Practice Address - Fax:702-368-2220
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist