Provider Demographics
NPI:1104471358
Name:SETLIFF, LANDRY DAVID (COTA)
Entity type:Individual
Prefix:
First Name:LANDRY
Middle Name:DAVID
Last Name:SETLIFF
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 PORT O CALL DR
Mailing Address - Street 2:
Mailing Address - City:RUNAWAY BAY
Mailing Address - State:TX
Mailing Address - Zip Code:76426-4503
Mailing Address - Country:US
Mailing Address - Phone:806-685-8557
Mailing Address - Fax:
Practice Address - Street 1:1800 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-2418
Practice Address - Country:US
Practice Address - Phone:325-365-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215820224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant