Provider Demographics
NPI:1467292896
Name:KNAPP, JEREMY W (COTA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:W
Last Name:KNAPP
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11804 160TH AVE NW # 160TH
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-5942
Mailing Address - Country:US
Mailing Address - Phone:253-678-5416
Mailing Address - Fax:
Practice Address - Street 1:11804 160TH AVE NW # 160TH
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98329-5942
Practice Address - Country:US
Practice Address - Phone:253-678-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60434275224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant