Individual
CANDACE HOLLY MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
428 MAIN ST, WINTERS, CA 95694-1830
(530) 794-6083
Mailing address
428 MAIN ST, WINTERS, CA 95694-1830
(530) 794-6083
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12045
CA
252Y00000X
Early Intervention Provider Agency
12045
CA
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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