Provider Demographics
NPI:1316187404
Name:RUNNELS, MARY-GUYTON HOLLEY (OTR/L CHT)
Entity Type:Individual
Prefix:MRS
First Name:MARY-GUYTON
Middle Name:HOLLEY
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:OTR/L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 ARNO RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2010
Mailing Address - Country:US
Mailing Address - Phone:816-444-4891
Mailing Address - Fax:
Practice Address - Street 1:6700 ANTIOCH RD
Practice Address - Street 2:430 SUITE
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-1258
Practice Address - Country:US
Practice Address - Phone:913-652-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS-1702374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist