Provider Demographics
NPI:1659561025
Name:CANDELA, IRENEO (OTR/ L)
Entity type:Individual
Prefix:MR
First Name:IRENEO
Middle Name:
Last Name:CANDELA
Suffix:
Gender:M
Credentials:OTR/ L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6706
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5118
Mailing Address - Country:US
Mailing Address - Phone:856-558-1268
Mailing Address - Fax:
Practice Address - Street 1:1924 EDGEWATER ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-2145
Practice Address - Country:US
Practice Address - Phone:856-558-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty