Provider Demographics
NPI:1154408680
Name:KNUTSON, KATHLEEN (MHS, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:MHS, OTR/L, CHT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:DEERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11674 SYMMES CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9396
Mailing Address - Country:US
Mailing Address - Phone:513-697-0478
Mailing Address - Fax:
Practice Address - Street 1:545 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3444
Practice Address - Country:US
Practice Address - Phone:859-331-4263
Practice Address - Fax:859-344-1711
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5538174400000X
OHOT003770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2981089Medicaid
OH2981089Medicaid