Provider Demographics
NPI:1568676997
Name:LANDENBERG, GAY JANEL (OTR)
Entity Type:Individual
Prefix:
First Name:GAY
Middle Name:JANEL
Last Name:LANDENBERG
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 1:2237 WESTERN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9412
Mailing Address - Country:US
Mailing Address - Phone:810-487-0665
Mailing Address - Fax:
Practice Address - Street 1:2237 WESTERN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-9412
Practice Address - Country:US
Practice Address - Phone:810-487-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004988225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist