Provider Demographics
NPI:1629441621
Name:KNOPES-NUXOLL, RANDI
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:KNOPES-NUXOLL
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 1:4204 E BEAUTY LN
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-4902
Mailing Address - Country:US
Mailing Address - Phone:509-552-1523
Mailing Address - Fax:
Practice Address - Street 1:19307 E CATALDO AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-9489
Practice Address - Country:US
Practice Address - Phone:509-228-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60270574225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist