Provider Demographics
NPI:1922298827
Name:KLEIN, CANDICE (CANDICE KLEIN)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:CANDICE KLEIN
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CANDICE KLEIN, LMT
Mailing Address - Street 1:320 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4214
Mailing Address - Country:US
Mailing Address - Phone:321-725-8347
Mailing Address - Fax:321-725-5191
Practice Address - Street 1:320 4TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4214
Practice Address - Country:US
Practice Address - Phone:321-725-8347
Practice Address - Fax:321-725-5191
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA8163225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist