Provider Demographics
NPI:1881019404
Name:YURKIEWICZ, KANDICE
Entity Type:Individual
Prefix:
First Name:KANDICE
Middle Name:
Last Name:YURKIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANDICE
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-1347
Mailing Address - Country:US
Mailing Address - Phone:609-296-9292
Mailing Address - Fax:
Practice Address - Street 1:1001 CENTER ST
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-1347
Practice Address - Country:US
Practice Address - Phone:609-296-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR006051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist