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General NPI Number Information
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NPI Number | 1275801987
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Entity Type | Individual
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Provider Name | SUSAN JOAN KNUTH OTR/L, ATP
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Gender | Female
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 1800 APPLETON RD EARLY INTERVENTION SERVICES
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City | MENASHA
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State | WI
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Zip | 54952-3727
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Country | US
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Telephone | 920-968-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 414 WASHINGTON AVE
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City | NEENAH
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State | WI
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Zip | 54956-3341
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Country | US
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Telephone | 920-729-5658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1625-26
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License Number State | WI
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