Provider Demographics
NPI:1912314550
Name:MCLEISTER, CANDY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:
Last Name:MCLEISTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:CRADDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10613 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10613 NW 38TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6003
Practice Address - Country:US
Practice Address - Phone:405-627-3159
Practice Address - Fax:800-281-5401
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115533225X00000X
OK1831225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist