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General NPI Number Information
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NPI Number | 1841602497
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Entity Type | Individual
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Provider Name | CANDACE HORTON C.T.R.S.
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Gender | Female
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 2589 COSTA MESA RD
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City | WATERFORD
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State | MI
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Zip | 48329-2430
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Country | US
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Telephone | 810-347-5587
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Fax |
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Provider Business Mailing Address
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Address Line | 2589 COSTA MESA RD
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City | WATERFORD
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State | MI
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Zip | 48329-2430
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Country | US
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Telephone | 810-347-5587
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 58857
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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