Provider Demographics
NPI:1346450129
Name:LANDERS, THEODORE SCOTT (OTC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:SCOTT
Last Name:LANDERS
Suffix:
Gender:M
Credentials:OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 SANTA FE LN
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1624
Mailing Address - Country:US
Mailing Address - Phone:708-467-0467
Mailing Address - Fax:815-327-1614
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-437-9889
Practice Address - Fax:847-301-2829
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other