Provider Demographics
NPI:1255538351
Name:EDLIN, CALANDRA STARK (OTR)
Entity type:Individual
Prefix:MRS
First Name:CALANDRA
Middle Name:STARK
Last Name:EDLIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108
Mailing Address - Country:US
Mailing Address - Phone:270-828-8059
Mailing Address - Fax:
Practice Address - Street 1:814 OLD EKRON RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1149
Practice Address - Country:US
Practice Address - Phone:270-422-2148
Practice Address - Fax:270-422-4791
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist