Provider Demographics
NPI:1992018733
Name:HUTTS, CANDACE LUE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LUE
Last Name:HUTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:IN
Mailing Address - Zip Code:47918-1147
Mailing Address - Country:US
Mailing Address - Phone:765-585-3337
Mailing Address - Fax:
Practice Address - Street 1:1600 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1715
Practice Address - Country:US
Practice Address - Phone:765-793-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99043191A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant