Healthcare Provider Details

I. General information

NPI: 1871663187
Provider Name (Legal Business Name): AMY L KNAUTZ OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 SUMMITVIEW AVE
YAKIMA WA
98902-2714
US

IV. Provider business mailing address

606 S 30TH AVE
YAKIMA WA
98902-4003
US

V. Phone/Fax

Practice location:
  • Phone: 509-965-6330
  • Fax: 509-972-0320
Mailing address:
  • Phone: 509-248-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT00002972
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: