Provider Demographics
NPI:1982731022
Name:KNOBBE, REINE JOAN
Entity Type:Individual
Prefix:
First Name:REINE
Middle Name:JOAN
Last Name:KNOBBE
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 420
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-0420
Mailing Address - Country:US
Mailing Address - Phone:636-528-7652
Mailing Address - Fax:636-528-2411
Practice Address - Street 1:951 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1112
Practice Address - Country:US
Practice Address - Phone:636-528-7652
Practice Address - Fax:636-528-2411
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475374708Medicaid