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General NPI Number Information
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NPI Number | 1487994000
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Entity Type | Individual
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Provider Name | CANDICE GOLIGHTLY OT
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Gender | Female
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 4341 PIEDMONT AVE SUITE #3
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City | OAKLAND
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State | CA
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Zip | 94611-4766
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Country | US
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Telephone | 510-333-4579
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Fax | 510-740-3491
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Provider Business Mailing Address
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Address Line | 1037 AQUARIUS WAY
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City | OAKLAND
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State | CA
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Zip | 94611-1939
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Country | US
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Telephone | 510-331-8000
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Fax | 510-740-3491
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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 | 7423
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 7423
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License Number State | CA
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