Provider Demographics
NPI:1306059381
Name:DONNELLYKNOX, CANDICE ELAINE (OTR)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELAINE
Last Name:DONNELLYKNOX
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512
Mailing Address - Country:US
Mailing Address - Phone:610-636-9842
Mailing Address - Fax:
Practice Address - Street 1:30 OLD SCHUYLKILL ROAD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465
Practice Address - Country:US
Practice Address - Phone:610-705-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist