Provider Demographics
NPI:1346720422
Name:CROWELL, CANDACE LANE (COTA)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LANE
Last Name:CROWELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 KILLGORE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-3700
Mailing Address - Country:US
Mailing Address - Phone:806-350-2259
Mailing Address - Fax:
Practice Address - Street 1:6600 KILLGORE DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-3700
Practice Address - Country:US
Practice Address - Phone:806-350-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
TX210502224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant