Provider Demographics
NPI:1497381008
Name:BREWER, CANDACE HEATHER
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:HEATHER
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 BOULDIN LN
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:TN
Mailing Address - Zip Code:38585-4633
Mailing Address - Country:US
Mailing Address - Phone:931-946-2213
Mailing Address - Fax:
Practice Address - Street 1:162 BOULDIN LN
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:TN
Practice Address - Zip Code:38585-4633
Practice Address - Country:US
Practice Address - Phone:931-946-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist