Provider Demographics
NPI:1437492410
Name:LANDIS, CARA LYNN (OT)
Entity type:Individual
Prefix:MISS
First Name:CARA
Middle Name:LYNN
Last Name:LANDIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:LYNN
Other - Last Name:EHST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:304 CHURCH ST
Mailing Address - Street 2:APT 6
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1934
Mailing Address - Country:US
Mailing Address - Phone:215-272-1438
Mailing Address - Fax:
Practice Address - Street 1:321 NORRISTOWN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2755
Practice Address - Country:US
Practice Address - Phone:215-272-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist