Provider Demographics
NPI:1699800664
Name:KOCHANOWICZ, RANDY P (OTRL)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:P
Last Name:KOCHANOWICZ
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 YELLOWSTONE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1834
Mailing Address - Country:US
Mailing Address - Phone:406-245-9330
Mailing Address - Fax:
Practice Address - Street 1:1415 YELLOWSTONE RIVER RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1834
Practice Address - Country:US
Practice Address - Phone:406-245-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist