Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC009462 | PA |
N | 225XE0001X | Environmental Modification | OC009462 | PA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC009462 | PA |
NPI | 1437770062 |
---|---|
Provider Name | Candice Marie Yendrzeiwski |
First Address | Nanticoke, PA 18634-3610 |
Second Address | Nanticoke, PA 18634-3610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2020 |
Last Update Date | 05/05/2020 |