Provider Demographics
NPI:1437355427
Name:SCOBEE, CANDRA KAY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CANDRA
Middle Name:KAY
Last Name:SCOBEE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 AVE R
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554
Mailing Address - Country:US
Mailing Address - Phone:620-257-8579
Mailing Address - Fax:
Practice Address - Street 1:108 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:KS
Practice Address - Zip Code:67546-8016
Practice Address - Country:US
Practice Address - Phone:620-585-6411
Practice Address - Fax:620-585-6504
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00232224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant