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General NPI Number Information
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NPI Number | 1851671796
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Entity Type | Individual
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Provider Name | KIM M KNUTSON OTR
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Gender | Female
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 601 CRAWFORD ST
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City | KELSO
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State | WA
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Zip | 98626-4315
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Country | US
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Telephone | 360-501-1904
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7072
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City | PUEBLO WEST
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State | CO
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Zip | 81007-0072
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Country | US
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Telephone | 719-696-1160
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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 | OT60868743
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License Number State | WA
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