Healthcare Provider Details

I. General information

NPI: 1073442620
Provider Name (Legal Business Name): SANDRA LEE KNOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 PATTERSON RD
GRAND JUNCTION CO
81506-8820
US

IV. Provider business mailing address

898 SAN LUIS CT
FRUITA CO
81521-6805
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-7734
  • Fax:
Mailing address:
  • Phone: 847-849-9725
  • Fax: 847-849-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT.0005074
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: