Individual
COURTNEY KNOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3130 CHATHAM RD STE A, SPRINGFIELD, IL 62704-5379
(844) 247-7222
(847) 348-3706
Mailing address
5 REVERE DR STE 120, NORTHBROOK, IL 60062-8005
(800) 356-4049
(941) 485-0519
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-149234
IL
224Z00000X
Occupational Therapy Assistant
057.005410
IL
Other
Enumeration date
01/13/2021
Last updated
01/14/2021
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