MEDICARE: RANDI SMALL AT, ATC

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	2255A2300X	Athletic Trainer	2601001501	MI

General Provider Information

NPI Number	:	1790130052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI SMALL AT, ATC

Provider Business Mailing Address
First Line	:	2200 N SQUIRREL RD
Second Line	:	ATHLETICS CENTER
City	:	ROCHESTER
State	:	MI
Zip	:	48309-4402
Country	:	US
Telephone Number	:	248-370-3132
Fax Number	:	248-370-4255

Provider Business Practice Location Address
First Line	:	2200 N SQUIRREL RD
Second Line	:	ATHLETICS CENTER
City	:	ROCHESTER
State	:	MI
Zip	:	48309-4402
Country	:	US
Telephone Number	:	248-370-3132
Fax Number	:	248-370-4255

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

Similar Medicare Providers

1760603047 — ANITHA RAJAGOPAL NP
Practice Location Address:

2200 N SQUIRREL RD , OAKLAND UNIVERSITY
ROCHESTER HILLS, MI
48309-4402

Practice Phone: 248-370-2341
Practice Fax:

1841447117 — OAKLAND UNIVERSITY
Practice Location Address:

2200 N SQUIRREL RD
ROCHESTER, MI
48309-4402

Practice Phone: 248-370-2341
Practice Fax:

1205134509 — OAKLAND UNIVERSITY GHC
Practice Location Address:

2200 N SQUIRREL RD
ROCHESTER, MI
48309-4402

Practice Phone: 248-370-2341
Practice Fax:

1396008728 — MATTHEW PAUL HERREMA MS, AT, ATC
Practice Location Address:

2200 N SQUIRREL RD
ROCHESTER, MI
48309-4402

Practice Phone: 248-370-3998
Practice Fax:

1134599509 — CHRISTIE MARIE RIVARD
Practice Location Address:

2200 N SQUIRREL RD
ROCHESTER, MI
48309-4402

Practice Phone: 248-370-2100
Practice Fax:

1376915264 — OAKLAND UNIVERSITY ABA CLINIC
Practice Location Address:

2200 N SQUIRREL RD , 260 D PAWLEY HALL
ROCHESTER, MI
48309-4402

Practice Phone: 248-370-3052
Practice Fax:

Directions to “ RANDI SMALL AT, ATC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.