Provider Demographics
NPI:1063035186
Name:KNITTEL, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:KNITTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-1431
Mailing Address - Country:US
Mailing Address - Phone:419-706-3931
Mailing Address - Fax:855-429-4118
Practice Address - Street 1:4 E SEMINARY ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2121
Practice Address - Country:US
Practice Address - Phone:567-424-6003
Practice Address - Fax:855-429-4118
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator