Provider Demographics
NPI:1568726396
Name:CANDELARIA, LAURIE LOUISE (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:LAURIE
Middle Name:LOUISE
Last Name:CANDELARIA
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 1:4641 ASHLEY VIEW LANE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405
Mailing Address - Country:US
Mailing Address - Phone:843-571-1346
Mailing Address - Fax:
Practice Address - Street 1:4641 ASHLEY VIEW LN
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-6759
Practice Address - Country:US
Practice Address - Phone:843-571-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist