Individual
MR. KENNETH WALLACE LANDEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
120 PLANT AVE, HAUPPAUGE, NY 11788-3805
(631) 851-3810
Mailing address
394 TOWNLINE RD, COMMACK, NY 11725-1424
(631) 499-4661
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
005537-1
NY
Other
Enumeration date
08/18/2006
Last updated
07/08/2007
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