Provider Demographics
NPI:1811716699
Name:NELSON, CANDI M (MSOTR/L)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:CANDI
Other - Middle Name:M
Other - Last Name:CREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-0673
Mailing Address - Country:US
Mailing Address - Phone:304-575-9980
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 673
Practice Address - Street 2:
Practice Address - City:CRAB ORCHARD
Practice Address - State:WV
Practice Address - Zip Code:25827-0673
Practice Address - Country:US
Practice Address - Phone:304-575-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2142225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics