Provider Demographics
NPI:1104897743
Name:STIKELEATHER, CANDACE FOX (OTRL)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:FOX
Last Name:STIKELEATHER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:DAWN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:1087 13TH ST SE
Mailing Address - Street 2:CHILDRENS NEUROTHERAPY SERVICES
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4165
Mailing Address - Country:US
Mailing Address - Phone:828-267-1688
Mailing Address - Fax:828-267-1690
Practice Address - Street 1:1087 13TH ST SE
Practice Address - Street 2:CHILDRENS NEUROTHERAPY SERVICES
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4165
Practice Address - Country:US
Practice Address - Phone:828-267-1688
Practice Address - Fax:828-267-1690
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5630225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301784Medicaid
NC139A6OtherBCBS
NCE0249OtherMEDCOST