Provider Demographics
NPI:1659410116
Name:DIAMOND-KRUPITSKY, CANDICE LISA (MS OTRL CHT)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:LISA
Last Name:DIAMOND-KRUPITSKY
Suffix:
Gender:F
Credentials:MS OTRL CHT
Other - Prefix:MS
Other - First Name:CANDICE
Other - Middle Name:LISA
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTRL CHT
Mailing Address - Street 1:11 KELLER RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1308
Mailing Address - Country:US
Mailing Address - Phone:410-415-5260
Mailing Address - Fax:410-415-5261
Practice Address - Street 1:11 KELLER RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1308
Practice Address - Country:US
Practice Address - Phone:410-415-5260
Practice Address - Fax:410-415-5261
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03982225XE1200X, 225XH1200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD670002023Medicare Oscar/Certification
639M140FMedicare PIN