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NPI Code Detail

MEDICARE: MR. RANDY H. WORDE OTR, CHT, CEAS

MEDICARE: MR. RANDY H. WORDE OTR, CHT, CEAS
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
1225XH1200XHand Occupational Therapist646TN

General Provider Information

NPI Number : 1740483635
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDY H. WORDE OTR, CHT, CEAS
Provider Business Mailing Address
First Line : 8823 PRODUCTION LN
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-6511
Country : US
Telephone Number : 423-238-7217
Fax Number : 423-238-3473
Provider Business Practice Location Address
First Line : 3575 KEITH ST NW
Second Line : STE 205
City : CLEVELAND
State : TN
Zip : 37312-4324
Country : US
Telephone Number : 423-559-0444
Fax Number : 423-559-0103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2007
Last Update Date : 11/13/2015

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