Provider Demographics
NPI:1871766816
Name:KNACKSTEDT, CAMILLA BETH (OTR/L)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:BETH
Last Name:KNACKSTEDT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 MAYES RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3437
Mailing Address - Country:US
Mailing Address - Phone:206-551-4307
Mailing Address - Fax:
Practice Address - Street 1:1025 NE PURCELL BLVD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7316
Practice Address - Country:US
Practice Address - Phone:541-312-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR238531225X00000X
WAOT60010440225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist