Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 004072 | NY |
NPI | 1003193905 |
---|---|
Provider Name | Mrs. Lisa Ann Landau |
First Address | Plainview, NY 11803-4047 |
Second Address | Plainview, NY 11803-4047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2011 |
Last Update Date | 07/11/2011 |