Provider Demographics
NPI:1023599941
Name:LANDRY, JEROME KEITH (OTR)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:KEITH
Last Name:LANDRY
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 SUNDANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2750
Mailing Address - Country:US
Mailing Address - Phone:830-221-1400
Mailing Address - Fax:
Practice Address - Street 1:2034 SUNDANCE PKWY
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2750
Practice Address - Country:US
Practice Address - Phone:830-221-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist