Active NPI
Candace L Mallin, OTR/L
- Occupational Therapist
- Sacramento, CA
National Provider Identifier
1306411392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 19588
- Practice address
- 2315 Stockton Blvd
Sacramento, CA 95817-2201 - Phone
- (916) 734-2011
- NPI assigned
- May 23, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 19588 | CA | Primary |
Addresses
Primary practice location
2315 Stockton Blvd
Sacramento, CA 95817-2201
Mailing address
531 N St
Lincoln, CA 95648-1523
Phone (815) 347-0888
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19588 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621728000000",
"number": "1306411392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "531 N ST",
"city": "LINCOLN",
"state": "CA",
"postal_code": "956481523",
"telephone_number": "815-347-0888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2315 STOCKTON BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958172201",
"telephone_number": "916-734-2011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLIN",
"first_name": "CANDACE",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-23",
"last_updated": "2021-05-23",
"certification_date": "2021-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "19588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.