Healthcare Provider Details

I. General information

NPI: 1477884807
Provider Name (Legal Business Name): MINDI KNUDSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINDI SCOTT OTR/L

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 BARNES BLVD SW
TUMWATER WA
98512-1435
US

IV. Provider business mailing address

4162 GROTTO CT SW
TUMWATER WA
98512-7824
US

V. Phone/Fax

Practice location:
  • Phone: 316-841-8528
  • Fax:
Mailing address:
  • Phone: 316-841-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003963
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: