MEDICARE: RANDY CLAY

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1144534660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY CLAY

Provider Business Mailing Address
First Line	:	PO BOX 2587
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-0587
Country	:	US
Telephone Number	:	707-571-2215
Fax Number	:	707-526-9672

Provider Business Practice Location Address
First Line	:	1207 CLEVELAND AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4729
Country	:	US
Telephone Number	:	707-571-2215
Fax Number	:	707-526-9672

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

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	10/14/2025

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