Provider Demographics
NPI:1366755373
Name:GILMAN, KANDACE (CP, CFM, LPO)
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:
Last Name:GILMAN
Suffix:
Gender:F
Credentials:CP, CFM, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N CHRISMAN RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9314
Mailing Address - Country:US
Mailing Address - Phone:509-469-9995
Mailing Address - Fax:509-469-9994
Practice Address - Street 1:317 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3213
Practice Address - Country:US
Practice Address - Phone:509-469-9995
Practice Address - Fax:509-469-9994
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000100222Z00000X
WAPS00000099224P00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter