Provider Demographics
NPI:1548569882
Name:PHELPS, JEANNE RUNYON (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:RUNYON
Last Name:PHELPS
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:CMR 402
Mailing Address - Street 2:LANDSTUHL REGIONAL MEDICAL CENTER
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:49637-286-0067
Mailing Address - Fax:49637-186-0067
Practice Address - Street 1:CMR 402
Practice Address - Street 2:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:49637-286-0067
Practice Address - Fax:49637-186-0067
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1568289225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics