Provider Demographics
NPI:1538551965
Name:KNOX, KATELYN PATRICIA (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:PATRICIA
Last Name:KNOX
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:PATRICIA
Other - Last Name:LIEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1306 W MAGNOLIA ST.
Mailing Address - Street 2:PMB 175
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521
Mailing Address - Country:US
Mailing Address - Phone:503-522-9418
Mailing Address - Fax:
Practice Address - Street 1:305 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2804
Practice Address - Country:US
Practice Address - Phone:503-522-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80109837Medicaid