Provider Demographics
NPI:1518638899
Name:CHEUNG, CANDICE OLIVIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:OLIVIA
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9627 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2015
Mailing Address - Country:US
Mailing Address - Phone:626-726-1505
Mailing Address - Fax:
Practice Address - Street 1:1575 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2675
Practice Address - Country:US
Practice Address - Phone:626-791-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22823225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist