Provider Demographics
NPI:1437770062
Name:YENDRZEIWSKI, CANDICE MARIE (MS, OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:YENDRZEIWSKI
Suffix:
Gender:F
Credentials:MS, OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E KIRMAR AVE
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3610
Mailing Address - Country:US
Mailing Address - Phone:570-814-5977
Mailing Address - Fax:
Practice Address - Street 1:115 GATEWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-4403
Practice Address - Country:US
Practice Address - Phone:570-938-4634
Practice Address - Fax:570-763-4374
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009462225XE0001X, 225XP0019X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation