Provider Demographics
NPI:1366617912
Name:OSBORNE, CANDICE LEE (OTR)
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:LEE
Last Name:OSBORNE
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 1:436 BROADWAY
Mailing Address - Street 2:#415
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3908
Mailing Address - Country:US
Mailing Address - Phone:214-794-9773
Mailing Address - Fax:
Practice Address - Street 1:436 BROADWAY
Practice Address - Street 2:#415
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3908
Practice Address - Country:US
Practice Address - Phone:214-794-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist