Provider Demographics
NPI:1417185463
Name:LANDAUER, ANGELA (OTR)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LANDAUER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7973
Mailing Address - Country:US
Mailing Address - Phone:402-721-8667
Mailing Address - Fax:
Practice Address - Street 1:2590 FOX RUN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7973
Practice Address - Country:US
Practice Address - Phone:402-721-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE993225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist