Provider Demographics
NPI:1447904115
Name:KNAB, THERESE A
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:A
Last Name:KNAB
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 1:1857 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7321
Mailing Address - Country:US
Mailing Address - Phone:805-667-8200
Mailing Address - Fax:805-667-8201
Practice Address - Street 1:1857 KNOLL DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7321
Practice Address - Country:US
Practice Address - Phone:805-667-8200
Practice Address - Fax:805-667-8201
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist