Basic Information
| Provider Information | |||||||||
| NPI: | 1083773758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANDELA | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 MOUNT VERNON RD | ||||||||
| Address2: | |||||||||
| City: | WURTSBORO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127905312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458884817 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 FLETCHER ST | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109241402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452948806 | ||||||||
| FaxNumber: | 8452948650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 006314-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.