Individual provider Active NPI

Landyn A Holder

  • Recreational Therapist Assistant
  • Waterford, MI
National Provider Identifier
1760396212
Registry record updated Oct 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Recreational Therapist AssistantTaxonomy code 226000000X
Practice address
3717 Embarcadero St
Waterford, MI 48329-2242
Phone
(248) 707-9902
NPI assigned
Oct 1, 2026
Last updated
Oct 1, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Recreational Therapist Assistant 226000000X NU Primary

Addresses

Primary practice location

3717 Embarcadero St
Waterford, MI 48329-2242

Mailing address

3717 Embarcadero St
Waterford, MI 48329-2242
Phone (248) 707-9902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790812800000",
    "number": "1760396212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3717 EMBARCADERO ST",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483292242",
            "telephone_number": "248-707-9902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3717 EMBARCADERO ST",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483292242",
            "telephone_number": "248-707-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDER",
        "first_name": "LANDYN",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-10-01",
        "last_updated": "2026-10-01",
        "certification_date": "2026-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "226000000X",
            "taxonomy_group": "",
            "desc": "Recreational Therapist Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.