Provider Demographics
NPI:1134493794
Name:LANDEAU, VANESSA LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:LANDEAU
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 TIBERON COVE RD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-2951
Mailing Address - Country:US
Mailing Address - Phone:407-617-6802
Mailing Address - Fax:
Practice Address - Street 1:34921 US HIGHWAY 19 N
Practice Address - Street 2:STE 450
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1969
Practice Address - Country:US
Practice Address - Phone:727-573-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12068224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant