MEDICARE: KATHRYN R GOTTFRIED RANDALL O.T.

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	225X00000X	Occupational Therapist	1799	NM
2	225X00000X	Occupational Therapist	17-02400	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225016751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN R GOTTFRIED RANDALL O.T.

Provider Business Mailing Address
First Line	:	6265 ROCK CHALK DR STE 1700
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-5232
Country	:	US
Telephone Number	:	785-838-7885
Fax Number	:	785-838-7885

Provider Business Practice Location Address
First Line	:	6265 ROCK CHALK DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-5232
Country	:	US
Telephone Number	:	785-838-7885
Fax Number	:	785-505-5311

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	05/29/2025

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