Provider Demographics
NPI:1154546851
Name:FLEMISTER, CANDY A
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:A
Last Name:FLEMISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22505 LATONIA LN
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1810
Mailing Address - Country:US
Mailing Address - Phone:708-369-0545
Mailing Address - Fax:708-679-1169
Practice Address - Street 1:22505 LATONIA LN
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1810
Practice Address - Country:US
Practice Address - Phone:708-369-0545
Practice Address - Fax:708-679-1169
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist