Provider Demographics
NPI:1396909925
Name:KNEZEVICH, KAROLINE (OTR/L06/18/1953)
Entity type:Individual
Prefix:MS
First Name:KAROLINE
Middle Name:
Last Name:KNEZEVICH
Suffix:
Gender:F
Credentials:OTR/L06/18/1953
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 WALLINGFORD ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-6613
Mailing Address - Country:US
Mailing Address - Phone:386-574-1235
Mailing Address - Fax:
Practice Address - Street 1:3650 MANSELL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-3012
Practice Address - Country:US
Practice Address - Phone:877-896-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11944225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist