Basic Information
| Provider Information | |||||||||
| NPI: | 1407068901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | RANDI | ||||||||
| MiddleName: | COLE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MA,OTR,L | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WEBER | ||||||||
| OtherFirstName: | RANDI | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | MA,OTR,L | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 180 MCAULAY PLACE | ||||||||
| Address2: | |||||||||
| City: | LAGUNA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494949332 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1700 ADAMS AVE 103 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145562288 | ||||||||
| FaxNumber: | 7144351745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2098 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.