NPIMap

Individual provider Active NPI

Candace Smith Raybon, OT

  • Occupational Therapist
  • Forest, MS
National Provider Identifier
1295098135
Registry record updated Jun 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT2450 Issued in MS
Practice address
1129 Hwy 35 S
Ste 2
Forest, MS 39232
Phone
(601) 469-1001
Fax
(601) 469-1009
NPI assigned
Jun 15, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT2450 MS Primary

Addresses

Primary practice location

1129 Hwy 35 S
Ste 2
Forest, MS 39232

Mailing address

2015 Highpointe Drive
Brandon, MS 39042
Phone (601) 824-8814

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT2450MSMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Medicomp, Inc PastSince Mar 15, 2011 Accepting new patients
Medicomp, Inc PastSince Nov 15, 2011 Accepting new patients
Medicomp, Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339718400000",
    "number": "1295098135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 HIGHPOINTE DRIVE",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "39042",
            "telephone_number": "601-824-8814",
            "fax_number": "601-824-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 HWY 35 S",
            "address_2": "STE 2",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "39232",
            "telephone_number": "601-469-1001",
            "fax_number": "601-469-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYBON",
        "first_name": "CANDACE",
        "middle_name": "SMITH",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-15",
        "last_updated": "2012-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT2450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; 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.