Provider Demographics
NPI:1427185156
Name:KNAUER, BEVERLY JEAN (OTR MPH)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JEAN
Last Name:KNAUER
Suffix:
Gender:F
Credentials:OTR MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1450
Mailing Address - Country:US
Mailing Address - Phone:619-501-8532
Mailing Address - Fax:
Practice Address - Street 1:6160 MISSION GORGE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3410
Practice Address - Country:US
Practice Address - Phone:619-528-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3227225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist