Provider Demographics
NPI:1205575800
Name:TEEL, CANDACE LEE
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LEE
Last Name:TEEL
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 1:3075 N FRONT RD
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-6558
Mailing Address - Country:US
Mailing Address - Phone:573-855-7861
Mailing Address - Fax:
Practice Address - Street 1:3075 N FRONT RD
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-6558
Practice Address - Country:US
Practice Address - Phone:573-855-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist