Individual provider Active NPI

Candice Marie Yendrzeiwski, MS, OTR/L, CLT

  • Occupational Therapist
  • Edwardsville, PA
National Provider Identifier
1437770062
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OC009462 Issued in PA
Practice address
115 Gateway Shopping Ctr
Edwardsville, PA 18704-4403
Phone
(570) 938-4634
Fax
(570) 763-4374
NPI assigned
May 5, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Environmental Modification Occupational Therapist 225XE0001X OC009462 PA
Physical Rehabilitation Occupational Therapist 225XP0019X OC009462 PA
Occupational Therapist 225X00000X OC009462 PA Primary

Addresses

Primary practice location

115 Gateway Shopping Ctr
Edwardsville, PA 18704-4403

Mailing address

114 E Kirmar Ave
Nanticoke, PA 18634-3610
Phone (570) 814-5977

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200902001836 PA Practitioner - Occupational Therapist in Private Practice 4981021151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hodi Lymphatic Center LLCGroup PAC ID 3072930247, 7 clinicians

Practice addresses (Care Compare)

115 Gateway Shopping Ctr
Edwardsville, PA 18704-4403
Phone (570) 938-4634

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
OC009462PAMDEnvironmental Modification Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hodi Lymphatic Center LLC Occupational Therapist CurrentSince Aug 6, 2020 Accepting new patients

Locations

115 Gateway Shopping Ctr
Kingston, PA 18704
Phone (570) 938-4634

Organizations & group practices 1

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": "1588636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667520000000",
    "number": "1437770062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 E KIRMAR AVE",
            "city": "NANTICOKE",
            "state": "PA",
            "postal_code": "186343610",
            "telephone_number": "570-814-5977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GATEWAY SHOPPING CTR",
            "city": "EDWARDSVILLE",
            "state": "PA",
            "postal_code": "187044403",
            "telephone_number": "570-938-4634",
            "fax_number": "570-763-4374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YENDRZEIWSKI",
        "first_name": "CANDICE",
        "middle_name": "MARIE",
        "credential": "MS, OTR/L, CLT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-05",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XE0001X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Environmental Modification",
            "state": "PA",
            "license": "OC009462",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "PA",
            "license": "OC009462",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC009462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.