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General NPI Number Information
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NPI Number | 1366755373
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Entity Type | Individual
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Provider Name | KANDACE GILMAN CP, CFM, LPO
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Gender | Female
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 317 S 11TH AVE
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City | YAKIMA
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State | WA
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Zip | 98902-3213
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Country | US
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Telephone | 509-469-9995
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Fax | 509-469-9994
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Provider Business Mailing Address
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Address Line | 1700 N CHRISMAN RD
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City | TRACY
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State | CA
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Zip | 95304-9314
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Country | US
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Telephone | 509-469-9995
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Fax | 509-469-9994
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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 | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | OI00000100
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | PS00000099
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number | PS00000099
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License Number State | WA
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