Individual
MRS. AUDREY MAE LANDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
331 E PARK ST, WEISER, ID 83672-2053
(208) 549-2416
(208) 549-0536
Mailing address
4430 CASA RIO DR, ONTARIO, OR 97914-8559
(541) 889-0830
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-102
ID
Other
Enumeration date
06/17/2008
Last updated
06/17/2008
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