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General NPI Number Information
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NPI Number | 1295161644
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Entity Type | Individual
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Provider Name | CANDACE FOLSOM
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Gender | Female
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 1700 PAMALEE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-2824
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Country | US
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Telephone | 910-488-8643
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Fax | 910-488-8644
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Provider Business Mailing Address
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Address Line | 3808 BURLINGTON DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28312-7022
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Country | US
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Telephone | 910-578-0760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4206
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License Number State | NC
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