Provider Demographics
NPI:1003861345
Name:BARRENTINE, CANDICE MARIE (OT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:BARRENTINE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-0712
Mailing Address - Country:US
Mailing Address - Phone:731-686-2010
Mailing Address - Fax:731-686-3798
Practice Address - Street 1:14075R S 1ST ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-6195
Practice Address - Country:US
Practice Address - Phone:731-686-2010
Practice Address - Fax:731-686-3798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT2560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist