Provider Demographics
NPI:1184031890
Name:RUNNELLS, SARAH (COTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUNNELLS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S MCCLINTOCK DR
Mailing Address - Street 2:#120
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4172
Mailing Address - Country:US
Mailing Address - Phone:719-334-2793
Mailing Address - Fax:
Practice Address - Street 1:6901 S MCCLINTOCK DR
Practice Address - Street 2:#120
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4172
Practice Address - Country:US
Practice Address - Phone:719-334-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5889224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant