Provider Demographics
NPI:1225358062
Name:BUGGS, CANDACE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:BUGGS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 N BEACON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5519
Mailing Address - Country:US
Mailing Address - Phone:773-275-7200
Mailing Address - Fax:
Practice Address - Street 1:4538 N BEACON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5519
Practice Address - Country:US
Practice Address - Phone:773-275-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056.007619OtherOCCUPATIONAL THERAPIST LICENSE