Provider Demographics
NPI:1932349164
Name:SEIBLY, CANDIA GAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CANDIA
Middle Name:GAY
Last Name:SEIBLY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4772 KATELLA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2600
Mailing Address - Country:US
Mailing Address - Phone:562-430-8700
Mailing Address - Fax:562-430-8760
Practice Address - Street 1:4772 KATELLA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2600
Practice Address - Country:US
Practice Address - Phone:562-430-8700
Practice Address - Fax:562-430-8760
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 3670174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist