Provider Demographics
NPI:1649441965
Name:LANDRY, STEVEN LYNN (OT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LYNN
Last Name:LANDRY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:LYNN
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:808 BAYOU LN
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4906
Mailing Address - Country:US
Mailing Address - Phone:985-447-3164
Mailing Address - Fax:985-447-5196
Practice Address - Street 1:808 BAYOU LN
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4906
Practice Address - Country:US
Practice Address - Phone:985-447-3164
Practice Address - Fax:985-447-5196
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11350225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand