Provider Demographics
NPI:1801130554
Name:LANDER, HEATHER J (MA, OTR/L)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:J
Last Name:LANDER
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MENTOR AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3373
Mailing Address - Country:US
Mailing Address - Phone:717-645-5927
Mailing Address - Fax:
Practice Address - Street 1:120 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3431
Practice Address - Country:US
Practice Address - Phone:626-357-9934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13003225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics