Provider Demographics
NPI:1730315516
Name:CARNEY, CANDICE RAE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:RAE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 S TOLEDO AVE APT 8N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3329
Mailing Address - Country:US
Mailing Address - Phone:918-277-6098
Mailing Address - Fax:
Practice Address - Street 1:4815 S HARVARD AVE STE 505
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3069
Practice Address - Country:US
Practice Address - Phone:918-749-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1050224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant