Provider Demographics
NPI:1851869119
Name:KNOLL, KATIE ESTEY (MS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ESTEY
Last Name:KNOLL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ESTEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3478 N. BROADWAY
Mailing Address - Street 2:APT. 418
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:509-981-2251
Mailing Address - Fax:708-231-7248
Practice Address - Street 1:55 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3100
Practice Address - Country:US
Practice Address - Phone:406-471-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012704225X00000X
MT10567225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist