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General NPI Number Information
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NPI Number | 1497648588
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Entity Type | Individual
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Provider Name | CANDACE HEBERT BAUMGARDNER OTD, OTR
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Gender | Female
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 17580 INTERSTATE 45 S
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City | SHENANDOAH
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State | TX
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Zip | 77384-4972
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Country | US
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Telephone | 936-267-7250
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Fax |
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Provider Business Mailing Address
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Address Line | 6202 WEDGEWOOD HILLS DR
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City | CONROE
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State | TX
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Zip | 77304-3198
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Country | US
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Telephone | 409-718-2310
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 124001
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License Number State | TX
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