Provider Demographics
NPI:1154846079
Name:KNIGHT, CAMILLE J
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:J
Last Name:KNIGHT
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 1:22005 76TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7905
Mailing Address - Country:US
Mailing Address - Phone:425-776-3800
Mailing Address - Fax:425-776-3844
Practice Address - Street 1:22005 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7905
Practice Address - Country:US
Practice Address - Phone:425-776-3800
Practice Address - Fax:425-776-3844
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60159932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist