Provider Demographics
NPI:1891181749
Name:CANODY, CANDICE NICHOLE (OTR/L, MSOT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:NICHOLE
Last Name:CANODY
Suffix:
Gender:F
Credentials:OTR/L, MSOT
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:CANODY
Other - Last Name:SPEAGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ORT/L, MSOT
Mailing Address - Street 1:184 SUNNY KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-8234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:184 SUNNY KNOLL LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-8234
Practice Address - Country:US
Practice Address - Phone:434-250-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005964225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist