Nicole S Landrum, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

32003594A Issued in IN

Practice address

333 W Mishawaka Rd
Elkhart, IN 46517-1921

Phone

(574) 293-1550

NPI assigned

Nov 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1942967476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 SOMERSET AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465444563",
            "telephone_number": "702-517-0957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 W MISHAWAKA RD",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465171921",
            "telephone_number": "574-293-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRUM",
        "first_name": "NICOLE",
        "middle_name": "S",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-18",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IN",
            "license": "32003594A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeshore Eyecare, Inc.
• Jessica Lyn Lala, MSW, LCSW
• Heather M Lamley
• Deniese L Lancianese, OTR
• Carly Elise Landon
• Orlando Landrum, MD
• Kitty Lange, RBT
• Elizabeth Langton, PHARMD, RPH
• Genevieve A Lankowicz, MD
• Stephen Morrell Lantz, MD

• Occupational Therapy Assistant in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Occupational Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.