MEDICARE: LEANNE CANDELORO OT

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	0907	NV

General Provider Information

NPI Number	:	1912103938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANNE CANDELORO OT

Provider Business Mailing Address
First Line	:	8070 W RUSSELL RD UNIT 2120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1561
Country	:	US
Telephone Number	:	702-461-8852
Fax Number	:	702-871-9671

Provider Business Practice Location Address
First Line	:	8070 W RUSSELL RD UNIT 2120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1561
Country	:	US
Telephone Number	:	702-461-8852
Fax Number	:	702-871-9671

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	08/09/2010

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