Provider Demographics
NPI:1992483671
Name:RANDAZZO, MARK STEVEN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:RANDAZZO
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 FAIR DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2321
Mailing Address - Country:US
Mailing Address - Phone:631-294-5903
Mailing Address - Fax:
Practice Address - Street 1:2300 FAIR DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2321
Practice Address - Country:US
Practice Address - Phone:631-294-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist