Provider Demographics
NPI:1346461654
Name:LARLHAM, CANDACE O (MAT, ATC, LAT)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:O
Last Name:LARLHAM
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9014 PATRIOT DRIVE
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241
Mailing Address - Country:US
Mailing Address - Phone:216-577-2570
Mailing Address - Fax:
Practice Address - Street 1:1 HOLY CROSS BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306
Practice Address - Country:US
Practice Address - Phone:330-773-9107
Practice Address - Fax:330-773-9100
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist