Individual
CANDACE SUSAN HAWTHORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, OTR/L
Contact information
Practice address
373 BURROWS ST, PITTSBURGH, PA 15213-2201
(412) 383-1555
Mailing address
1206 OLD CONCORD RD, MONROEVILLE, PA 15146-4848
(412) 856-6772
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS017192
PA
225XP0200X
Pediatric Occupational Therapist
OC000231L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01922084
MA PROVIDER NUMBER
PA
Enumeration date
03/12/2007
Last updated
02/07/2013
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