Provider Demographics
NPI:1295161644
Name:FOLSOM, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:FOLSOM
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 1:3808 BURLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7022
Mailing Address - Country:US
Mailing Address - Phone:910-578-0760
Mailing Address - Fax:
Practice Address - Street 1:1700 PAMALEE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-2824
Practice Address - Country:US
Practice Address - Phone:910-488-8643
Practice Address - Fax:910-488-8644
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4206225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist