Provider Demographics
NPI:1215964267
Name:KNUTSON, TAVI
Entity type:Individual
Prefix:
First Name:TAVI
Middle Name:
Last Name:KNUTSON
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 1:227 16TH ST W SUITE 100
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5268
Mailing Address - Country:US
Mailing Address - Phone:701-225-0767
Mailing Address - Fax:701-225-7123
Practice Address - Street 1:227 16TH ST W SUITE 100
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5268
Practice Address - Country:US
Practice Address - Phone:701-225-0767
Practice Address - Fax:701-225-7123
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist