Provider Demographics
NPI:1598883589
Name:KNOLLES, CARA JEANETTE
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:JEANETTE
Last Name:KNOLLES
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 1:15021 SE 177TH PL APT H
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9074
Mailing Address - Country:US
Mailing Address - Phone:206-498-3826
Mailing Address - Fax:
Practice Address - Street 1:15021 SE 177TH PL APT H
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-9074
Practice Address - Country:US
Practice Address - Phone:206-498-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022894225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0217863OtherDEPT OF LABOR AND INDUST