Provider Demographics
NPI:1083020382
Name:LANDMANN, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LANDMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PLUM NEARLY LN
Mailing Address - Street 2:APT J
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2772
Mailing Address - Country:US
Mailing Address - Phone:828-273-9563
Mailing Address - Fax:
Practice Address - Street 1:504 PLUM NEARLY LN
Practice Address - Street 2:APT J
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2772
Practice Address - Country:US
Practice Address - Phone:828-273-9563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9223224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant