Provider Demographics
NPI:1174740377
Name:CAUDLE, RANDY LAVERNE (OTR)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:LAVERNE
Last Name:CAUDLE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 CAHABA VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124
Mailing Address - Country:US
Mailing Address - Phone:205-314-7227
Mailing Address - Fax:205-314-7222
Practice Address - Street 1:245 CAHABA VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2216
Practice Address - Country:US
Practice Address - Phone:205-314-7227
Practice Address - Fax:205-314-7222
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2366225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521531OtherBCBS