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NPI Code Detail

MEDICARE: CANDICE DAWN LIEDES OTR/L

MEDICARE: CANDICE DAWN LIEDES 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
1225X00000XOccupational TherapistOT00003524WA

General Provider Information

NPI Number : 1679830673
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDICE DAWN LIEDES OTR/L
Provider Business Mailing Address
First Line : PO BOX 1265
Second Line :
City : GRAHAM
State : WA
Zip : 98338-1265
Country : US
Telephone Number : 253-208-2821
Fax Number :
Provider Business Practice Location Address
First Line : 516 176TH ST E
Second Line :
City : SPANAWAY
State : WA
Zip : 98387-8335
Country : US
Telephone Number : 253-208-2821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2012
Last Update Date : 03/12/2024

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