Provider Demographics
NPI:1770615817
Name:KNIEPKAMP, CHRISTY LEA (OT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:LEA
Last Name:KNIEPKAMP
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 PINON DUNKEN RD
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:NM
Mailing Address - Zip Code:88344-9706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2218 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1624
Practice Address - Country:US
Practice Address - Phone:505-748-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB7959Medicare ID - Type Unspecified