Provider Demographics
NPI:1093072779
Name:RUNYON, MARILYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:RUNYON
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 1:700 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERBROOK
Mailing Address - State:KS
Mailing Address - Zip Code:66524-9496
Mailing Address - Country:US
Mailing Address - Phone:785-665-7124
Mailing Address - Fax:
Practice Address - Street 1:700 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OVERBROOK
Practice Address - State:KS
Practice Address - Zip Code:66524-9496
Practice Address - Country:US
Practice Address - Phone:785-665-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17-01563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist