1922298827 NPI number — MRS. CANDICE KLEIN CANDICE KLEIN

Table of content: MRS. CANDICE KLEIN CANDICE KLEIN (NPI 1922298827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922298827 NPI number — MRS. CANDICE KLEIN CANDICE KLEIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
CANDICE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CANDICE KLEIN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEIN
Provider Other First Name:
CANDICE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CANDICE KLEIN, LMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922298827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIALANTIC
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32903-4214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-725-8347
Provider Business Mailing Address Fax Number:
321-725-5191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIALANTIC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32903-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-725-8347
Provider Business Practice Location Address Fax Number:
321-725-5191
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA8163 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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