Provider Demographics
NPI:1952137994
Name:KNELL, ELIZABETH ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:KNELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4203
Mailing Address - Country:US
Mailing Address - Phone:617-874-7799
Mailing Address - Fax:
Practice Address - Street 1:10P GILL ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1721
Practice Address - Country:US
Practice Address - Phone:781-932-2888
Practice Address - Fax:781-932-9809
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist