Provider Demographics
NPI:1417001322
Name:LANDHOLM, SANSHA Y (OT)
Entity Type:Individual
Prefix:
First Name:SANSHA
Middle Name:Y
Last Name:LANDHOLM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68045-1630
Mailing Address - Country:US
Mailing Address - Phone:402-685-6426
Mailing Address - Fax:
Practice Address - Street 1:430 N MONITOR ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1555
Practice Address - Country:US
Practice Address - Phone:402-372-2372
Practice Address - Fax:402-372-6773
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist