MEDICARE: MRS. JUDITH ANN MCKNIGHT OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XM0800X	Mental Health Occupational Therapist	OT002730	GA

General Provider Information

NPI Number	:	1790969095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH ANN MCKNIGHT OTR

Provider Business Mailing Address
First Line	:	2493 WILLIAM FEW PKWY
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-7436
Country	:	US
Telephone Number	:	706-504-7105
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 EAST HOSPITAL ROAD
Second Line	:
City	:	FORT GORDON
State	:	GA
Zip	:	30905-0000
Country	:	US
Telephone Number	:	706-504-7105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	03/22/2023

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