Provider Demographics
NPI:1801447115
Name:SHARI LANDRY OT
Entity type:Organization
Organization Name:SHARI LANDRY OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT, OTR/L
Authorized Official - Phone:203-641-0492
Mailing Address - Street 1:1475 FOLSOM ST APT 3003
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6845
Mailing Address - Country:US
Mailing Address - Phone:203-641-0492
Mailing Address - Fax:
Practice Address - Street 1:1475 FOLSOM ST APT 3003
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6845
Practice Address - Country:US
Practice Address - Phone:203-641-0492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty