Provider Demographics
NPI:1285277541
Name:BRUCE, CANDICE (COTA/L)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9341
Mailing Address - Country:US
Mailing Address - Phone:757-269-1531
Mailing Address - Fax:
Practice Address - Street 1:6701 IRONBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1469
Practice Address - Country:US
Practice Address - Phone:804-621-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001985224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant