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General NPI Number Information
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NPI Number | 1932749199
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Entity Type | Individual
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Provider Name | CARISSA MAE KNOTT
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Gender | Female
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 303 CATLIN ST
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City | BUFFALO
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State | MN
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Zip | 55313-1947
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Country | US
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Telephone | 763-682-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 188 CALDER AVE SE
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City | BUFFALO
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State | MN
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Zip | 55313-4817
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Country | US
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Telephone | 763-807-2957
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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 | TL5756
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License Number State | MN
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