Provider Demographics
NPI:1841602497
Name:HORTON, CANDACE (CTRS)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 COSTA MESA RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2430
Mailing Address - Country:US
Mailing Address - Phone:810-347-5587
Mailing Address - Fax:
Practice Address - Street 1:2589 COSTA MESA RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-2430
Practice Address - Country:US
Practice Address - Phone:810-347-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI58857225800000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other