Provider Demographics
NPI:1588856439
Name:ANDERSON, CANDACE (COTA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 MONTANA CIR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9718
Mailing Address - Country:US
Mailing Address - Phone:704-788-4747
Mailing Address - Fax:704-821-0570
Practice Address - Street 1:598 INDIAN TRAIL RD S STE 141
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8689
Practice Address - Country:US
Practice Address - Phone:704-975-7008
Practice Address - Fax:704-821-0570
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6581224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant