MEDICARE: SHARI LANDRY OT

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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1801447115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARI LANDRY OT

Provider Business Mailing Address
First Line	:	1475 FOLSOM ST APT 3003
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-6845
Country	:	US
Telephone Number	:	203-641-0492
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 FOLSOM ST APT 3003
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-6845
Country	:	US
Telephone Number	:	203-641-0492
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	SHARI LYN LANDRY
Credential	:	MSOT, OTR/L
Telephone Number	:	203-641-0492

Provider Enumeration Date	:	09/27/2019
Last Update Date	:	09/27/2019

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