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General NPI Number Information
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NPI Number | 1376911628
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Entity Type | Individual
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Provider Name | CANDACE MALHOTRA
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Gender | Female
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 1000 EDGEWOOD DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-2105
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Country | US
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Telephone | 937-645-6729
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Fax | 937-642-9909
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Provider Business Mailing Address
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Address Line | 1000 EDGEWOOD DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-2105
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Country | US
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Telephone | 937-645-6729
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Fax | 937-642-9909
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | OH
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