Individual
NICOLE S LANDRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
333 W MISHAWAKA RD, ELKHART, IN 46517-1921
(574) 293-1550
Mailing address
921 SOMERSET AVE, MISHAWAKA, IN 46544-4563
(702) 517-0957
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003594A
IN
Other
Enumeration date
11/18/2021
Last updated
11/18/2021
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