Provider Demographics
NPI:1972748440
Name:KNUTH, HOLLY ROSE (OTR)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ROSE
Last Name:KNUTH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SHADY OAK CT
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6034
Mailing Address - Country:US
Mailing Address - Phone:507-454-0000
Mailing Address - Fax:507-454-0000
Practice Address - Street 1:3501 PARK LANE DRIVE
Practice Address - Street 2:HILLVIEW HEALTH CARE CENTER
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-789-4800
Practice Address - Fax:608-789-7882
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI875026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40808200Medicaid