Provider Demographics
NPI:1902032642
Name:KNIGHT, CARLY RENAE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:RENAE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:CARLY
Other - Middle Name:RENAE
Other - Last Name:BORZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3905 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2639
Mailing Address - Country:US
Mailing Address - Phone:405-670-5569
Mailing Address - Fax:405-670-5571
Practice Address - Street 1:3905 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2639
Practice Address - Country:US
Practice Address - Phone:405-670-5569
Practice Address - Fax:405-670-5571
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist