Provider Demographics
NPI:1528212453
Name:GOTTFRIED, CANDACE D
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:D
Last Name:GOTTFRIED
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 1:4009 GRAHAM NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9071
Mailing Address - Country:US
Mailing Address - Phone:919-233-0940
Mailing Address - Fax:919-233-1035
Practice Address - Street 1:7829 PERCUSSION DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-3611
Practice Address - Country:US
Practice Address - Phone:919-363-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist