Provider Demographics
NPI:1033775135
Name:LANDRY, SHARI LYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LYN
Last Name:LANDRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 FOLSOM ST APT 3003
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6845
Mailing Address - Country:US
Mailing Address - Phone:203-641-0492
Mailing Address - Fax:
Practice Address - Street 1:7400 W QUINCY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-1202
Practice Address - Country:US
Practice Address - Phone:303-495-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005168225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty