Provider Demographics
NPI:1568857381
Name:RUNSER, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:RUNSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10339 LAKE PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-2533
Mailing Address - Country:US
Mailing Address - Phone:814-825-8309
Mailing Address - Fax:
Practice Address - Street 1:10339 LAKE PLEASANT RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-2533
Practice Address - Country:US
Practice Address - Phone:814-825-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007149224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant