Provider Demographics
NPI:1548639214
Name:LANDRY, CLARE LOUISE (MS OT)
Entity type:Individual
Prefix:MISS
First Name:CLARE
Middle Name:LOUISE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E 61ST ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8133
Mailing Address - Country:US
Mailing Address - Phone:504-710-8338
Mailing Address - Fax:
Practice Address - Street 1:147 W 35TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2110
Practice Address - Country:US
Practice Address - Phone:212-842-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63020033174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist