Provider Demographics
NPI:1528377967
Name:LORENTO, CANDICE MARIE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:LORENTO
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0586
Mailing Address - Country:US
Mailing Address - Phone:631-866-6507
Mailing Address - Fax:631-325-3407
Practice Address - Street 1:295 MONTAUK HIGHWAY
Practice Address - Street 2:STORE 12
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972-0586
Practice Address - Country:US
Practice Address - Phone:631-866-6507
Practice Address - Fax:631-325-3407
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist