Candace Holly Mack, OTR/L

Primary specialty

SpecialistTaxonomy code 174400000X

License

12045 Issued in CA

Practice address

428 Main St
Winters, CA 95694-1830

Phone

(530) 794-6083

NPI assigned

Nov 9, 2011

Last updated

Nov 9, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320796800000",
    "number": "1114204849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 MAIN ST",
            "city": "WINTERS",
            "state": "CA",
            "postal_code": "956941830",
            "telephone_number": "530-794-6083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 MAIN ST",
            "city": "WINTERS",
            "state": "CA",
            "postal_code": "956941830",
            "telephone_number": "530-794-6083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "CANDACE",
        "middle_name": "HOLLY",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-09",
        "last_updated": "2011-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "12045",
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "CA",
            "license": "12045",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgina Olazaran Jamison, DDS
• Carla J Kakutani, M.D.
• Kristin Lakoma
• Jaime Lopez, P.A.
• Jesus Javier Luna, PH.D.
• Euphemia Matondo
• Daniel G Mazza, D.D.S.
• Katie Medina Diaz
• Holly Lynn Moen, CNM
• Esteban Montano, AMFT

• Specialist in Winters, CA
• Providers in Winters, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.