Provider Demographics
NPI:1235254913
Name:KNIGHT-WILKINS, CLEOPATRA PETERSON (OTR)
Entity Type:Individual
Prefix:
First Name:CLEOPATRA
Middle Name:PETERSON
Last Name:KNIGHT-WILKINS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 A MARINA DRIVE
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045
Mailing Address - Country:US
Mailing Address - Phone:617-571-8892
Mailing Address - Fax:
Practice Address - Street 1:10 A MARINA DRIVE
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045
Practice Address - Country:US
Practice Address - Phone:617-571-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH 1897-OT225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation