Basic Information
| Provider Information | |||||||||
| NPI: | 1295098135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAYBON | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | SMITH | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2015 HIGHPOINTE DRIVE | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018248814 | ||||||||
| FaxNumber: | 6018248816 | ||||||||
| Practice Location | |||||||||
| Address1: | 1129 HWY 35 S | ||||||||
| Address2: | STE 2 | ||||||||
| City: | FOREST | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014691001 | ||||||||
| FaxNumber: | 6014691009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2012 | ||||||||
| LastUpdateDate: | 06/15/2012 | ||||||||
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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 | 225X00000X | OT2450 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.