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General NPI Number Information
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NPI Number | 1023166501
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Entity Type | Organization
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Legal Business Name | S J KNACKSTEDT INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4516 ALTURA PLACE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5706
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Country | US
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Telephone | 505-265-3959
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Fax | 505-262-9222
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Provider Business Mailing Address
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Address Line | 4516 ALTURA PLACE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5706
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Country | US
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Telephone | 505-265-3959
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Fax | 505-262-9222
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVE JAY KNACKSTEDT
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Credential | OT
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Telephone | 505-265-3959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 144
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License Number State | NM
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