Provider Demographics
NPI:1982807327
Name:KNAUTZ, SERENA PRATHER (OTR/L)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:PRATHER
Last Name:KNAUTZ
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 1:6510 NORMAN CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8963
Mailing Address - Country:US
Mailing Address - Phone:773-428-8711
Mailing Address - Fax:
Practice Address - Street 1:6510 NORMAN CT
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8963
Practice Address - Country:US
Practice Address - Phone:773-428-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166076225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics