Provider Demographics
NPI:1851516355
Name:ROTHENBUHLER, CANDICE (COTA)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:ROTHENBUHLER
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 1:7435 OLD STATE ROAD 67 N
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-9359
Mailing Address - Country:US
Mailing Address - Phone:317-834-2455
Mailing Address - Fax:317-831-7999
Practice Address - Street 1:7435 OLD STATE ROAD 67 N
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-9359
Practice Address - Country:US
Practice Address - Phone:317-834-2455
Practice Address - Fax:317-831-7999
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001069A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant