Provider Demographics
NPI:1790906352
Name:LANDRY, GAIL (OT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:LANDRY
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 1:3309 S MEAD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2629
Mailing Address - Country:US
Mailing Address - Phone:206-909-1302
Mailing Address - Fax:
Practice Address - Street 1:430 E. 162 STREET
Practice Address - Street 2:SUITE 246
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473
Practice Address - Country:US
Practice Address - Phone:708-466-8351
Practice Address - Fax:708-201-7468
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56007098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist