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General NPI Number Information
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NPI Number | 1902698681
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Entity Type | Individual
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Provider Name | CANDYCE BANKS OTR
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Gender | Female
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 640 E 168TH PL
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-3018
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Country | US
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Telephone | 708-333-7812
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Fax |
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Provider Business Mailing Address
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Address Line | 152 E 162ND LN
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2197
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Country | US
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Telephone | 773-383-7127
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.015267
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License Number State | IL
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