Provider Demographics
NPI:1003060658
Name:PANTOGA, CANDACE LEIGH (OTR, MS)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LEIGH
Last Name:PANTOGA
Suffix:
Gender:F
Credentials:OTR, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-2146
Mailing Address - Country:US
Mailing Address - Phone:608-250-2538
Mailing Address - Fax:
Practice Address - Street 1:3030 CITY VIEW DRIVE
Practice Address - Street 2:CITY VIEW NURSING HOME
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718
Practice Address - Country:US
Practice Address - Phone:608-242-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2293-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist