Provider Demographics
NPI:1932253804
Name:KNOLL, LAURI S (OT)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:S
Last Name:KNOLL
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 1:162 TARLETON ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2364
Mailing Address - Country:US
Mailing Address - Phone:318-240-7680
Mailing Address - Fax:318-240-7681
Practice Address - Street 1:554 TUNICA DR W
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2627
Practice Address - Country:US
Practice Address - Phone:318-240-7680
Practice Address - Fax:318-240-7681
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTTZ11736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X730Medicare ID - Type Unspecified