Provider Demographics
NPI:1689495947
Name:KARSCH, CANDICE SHIRLEY
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:SHIRLEY
Last Name:KARSCH
Suffix:
Gender:F
Credentials:
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 55
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-0055
Mailing Address - Country:US
Mailing Address - Phone:937-222-3345
Mailing Address - Fax:
Practice Address - Street 1:78 S TERRY ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-1810
Practice Address - Country:US
Practice Address - Phone:937-222-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6859225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist