Provider Demographics
NPI:1821749201
Name:WILLIAMS, CANDACE CHARISSE (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:CHARISSE
Last Name:WILLIAMS
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 1:2379 MILAN ST BLDG D
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5791
Mailing Address - Country:US
Mailing Address - Phone:347-642-0936
Mailing Address - Fax:
Practice Address - Street 1:487 E MOORESTOWN RD STE 112
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-9683
Practice Address - Country:US
Practice Address - Phone:347-642-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018008225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation