Basic Information
| Provider Information | |||||||||
| NPI: | 1013502509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNOWLES | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CHILDRENS AVE STE BA | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731044637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052713644 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 CHILDRENS AVE STE BA | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731044637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052713644 | ||||||||
| FaxNumber: | 4052711907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Z00000X | 77 | OK | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist | 224P00000X | 125 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Prosthetist |
No ID Information.