MEDICARE: MS. MICHELE LYNN LANDRY OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT1553	ME

General Provider Information

NPI Number	:	1649330754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE LYNN LANDRY OTR

Provider Business Mailing Address
First Line	:	39 LIMERICK RD
Second Line	:
City	:	ARUNDEL
State	:	ME
Zip	:	04046-8158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 LIMERICK RD
Second Line	:
City	:	ARUNDEL
State	:	ME
Zip	:	04046-8158
Country	:	US
Telephone Number	:	207-423-8754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/06/2023

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