Provider Demographics
NPI:1225708845
Name:KNAPKE, BRIANNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:KNAPKE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11024 CONOVER RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-9477
Mailing Address - Country:US
Mailing Address - Phone:567-644-3150
Mailing Address - Fax:
Practice Address - Street 1:11230 STATE ROUTE 364
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-9534
Practice Address - Country:US
Practice Address - Phone:419-394-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007556224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant