MEDICARE: MS. RANDY J GOOTZEIT MS, OTR/L, CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	3735	AZ

General Provider Information

NPI Number	:	1578582862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RANDY J GOOTZEIT MS, OTR/L, CHT

Provider Business Mailing Address
First Line	:	1245 E CHOLLA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-1171
Country	:	US
Telephone Number	:	602-228-9843
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 E CHOLLA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-1171
Country	:	US
Telephone Number	:	602-228-9843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/28/2010

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