=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861982217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI KNITTER ED.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2018
-----------------------------------------------------
Last Update Date | 05/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SHORT PUMP MIDDLE SCHOOL, 4701 POUNCEY TRACT RD PSYCHOLOGY OFFICE
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23059-2323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-306-3825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12007 SUNRISE RD
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23233-1603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-306-3825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------