Provider Demographics
NPI:1831922871
Name:CALLAHAN, KNITOCKI
Entity type:Individual
Prefix:
First Name:KNITOCKI
Middle Name:
Last Name:CALLAHAN
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:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:MACCLESFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27852-0455
Mailing Address - Country:US
Mailing Address - Phone:252-363-1451
Mailing Address - Fax:984-220-9263
Practice Address - Street 1:PO BOX 455
Practice Address - Street 2:
Practice Address - City:MACCLESFIELD
Practice Address - State:NC
Practice Address - Zip Code:27852-0455
Practice Address - Country:US
Practice Address - Phone:252-363-1451
Practice Address - Fax:984-220-9263
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)