Provider Demographics
NPI:1194922518
Name:KNOWLTON, AMY LEIGH (CTRS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 SCENICVIEW DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3485
Mailing Address - Country:US
Mailing Address - Phone:216-491-6073
Mailing Address - Fax:
Practice Address - Street 1:4100 WARRENSVILLE CENTER RD
Practice Address - Street 2:BUILDING A, 4TH FLOOR
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-491-6073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50044225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist