MEDICARE: MRS. RANDI KAY JORDAN OT

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	115690	TX

General Provider Information

NPI Number	:	1326474305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RANDI KAY JORDAN OT

Provider Business Mailing Address
First Line	:	2277 RISING BAY CT
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-7182
Country	:	US
Telephone Number	:	936-402-2257
Fax Number	:

Provider Business Practice Location Address
First Line	:	8603 BROADWAY ST STE 170
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-8171
Country	:	US
Telephone Number	:	936-402-2257
Fax Number	:

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

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	05/03/2024

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