Provider Demographics
NPI:1174021638
Name:KNOWLES, KEARSTI-RAE E (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:KEARSTI-RAE
Middle Name:E
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 GURLER ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3631
Mailing Address - Country:US
Mailing Address - Phone:815-441-9889
Mailing Address - Fax:
Practice Address - Street 1:223 GURLER ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3631
Practice Address - Country:US
Practice Address - Phone:815-441-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11834225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist