Provider Demographics
NPI:1386045847
Name:WAERING, CANDICE (MS, OT/L)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:WAERING
Suffix:
Gender:F
Credentials:MS, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 VAN BRUNT ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-9337
Mailing Address - Country:US
Mailing Address - Phone:570-877-9749
Mailing Address - Fax:
Practice Address - Street 1:312 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1555
Practice Address - Country:US
Practice Address - Phone:570-343-1950
Practice Address - Fax:570-343-1951
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009195225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist