Provider Demographics
NPI:1134409634
Name:LANDERS, MICHELLE DENISE (OTR)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DENISE
Last Name:LANDERS
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 1:1202 S FM 116 APT 11107
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-3657
Mailing Address - Country:US
Mailing Address - Phone:317-828-6194
Mailing Address - Fax:
Practice Address - Street 1:1202 S FM 116 APT 11107
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3657
Practice Address - Country:US
Practice Address - Phone:317-828-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000580A174400000X
TX118458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist