Provider Demographics
NPI:1730968330
Name:KNOOP, LYDIA ROSE (OTR/L)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ROSE
Last Name:KNOOP
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 1:34 HEMLOCK LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-3407
Mailing Address - Country:US
Mailing Address - Phone:716-903-7934
Mailing Address - Fax:
Practice Address - Street 1:5190 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4324
Practice Address - Country:US
Practice Address - Phone:716-651-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist