Healthcare Provider Details

I. General information

NPI: 1083519094
Provider Name (Legal Business Name): ONNA MARIE KNOLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KODA MARIE KNOLES

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 166TH PL NE STE 202B
ARLINGTON WA
98223-8403
US

IV. Provider business mailing address

2100 172ND ST NE UNIT E203
MARYSVILLE WA
98271-4948
US

V. Phone/Fax

Practice location:
  • Phone: 425-949-0801
  • Fax:
Mailing address:
  • Phone: 620-218-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: