Provider Demographics
NPI:1871663187
Name:KNAUTZ, AMY L (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:KNAUTZ
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 S 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4003
Mailing Address - Country:US
Mailing Address - Phone:509-248-0121
Mailing Address - Fax:
Practice Address - Street 1:3704 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2714
Practice Address - Country:US
Practice Address - Phone:509-965-6330
Practice Address - Fax:509-972-0320
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002972174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist