MEDICARE: AMY M MCCANDLESS M.S./OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	002411-1	NY

General Provider Information

NPI Number	:	1497063820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY M MCCANDLESS M.S./OTR/L

Provider Business Mailing Address
First Line	:	51 PRIMROSE ST
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10606-1619
Country	:	US
Telephone Number	:	914-948-2948
Fax Number	:	914-948-2948

Provider Business Practice Location Address
First Line	:	51 PRIMROSE ST
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10606-1619
Country	:	US
Telephone Number	:	914-948-2948
Fax Number	:	914-948-2948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	09/20/2010

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