Provider Demographics
NPI:1891165064
Name:CARANDANG, JUSTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:CARANDANG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 WARM SPRINGS RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLEN
Mailing Address - State:CA
Mailing Address - Zip Code:95442-8754
Mailing Address - Country:US
Mailing Address - Phone:551-587-3773
Mailing Address - Fax:
Practice Address - Street 1:5139 WARM SPRINGS RD UNIT A
Practice Address - Street 2:
Practice Address - City:GLEN ELLEN
Practice Address - State:CA
Practice Address - Zip Code:95442-8754
Practice Address - Country:US
Practice Address - Phone:551-587-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12798225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist