Provider Demographics
NPI:1043598097
Name:KNOOP, ANNE K
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:K
Last Name:KNOOP
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 1:4831 E HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2725
Mailing Address - Country:US
Mailing Address - Phone:317-902-0743
Mailing Address - Fax:
Practice Address - Street 1:4831 E HAMPTON ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2725
Practice Address - Country:US
Practice Address - Phone:317-902-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004130A225X00000X
WAOT60174150225X00000X
AZ4842225X00000X
AZBH5312385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5312OtherARIZONA DEPARTMENT OF HEALTH SERVICES