Provider Demographics
NPI:1114691128
Name:KNOTTS, HAZEL GAMAL
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:GAMAL
Last Name:KNOTTS
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 1:3305 KRINER RD
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8702
Mailing Address - Country:US
Mailing Address - Phone:740-645-0654
Mailing Address - Fax:
Practice Address - Street 1:3305 KRINER RD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8702
Practice Address - Country:US
Practice Address - Phone:740-645-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide