Provider Demographics
NPI:1851637995
Name:RUNKLE, JULIA MARIAH (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MARIAH
Last Name:RUNKLE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MARIAH
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR
Mailing Address - Street 1:6535 SOUTH DAYTON ST
Mailing Address - Street 2:#3800
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-649-9007
Mailing Address - Fax:303-649-9008
Practice Address - Street 1:6535 SOUTH DAYTON ST
Practice Address - Street 2:#3800
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-649-9007
Practice Address - Fax:303-649-9008
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003573225X00000X
CO003573225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0003573Medicaid
CO0003573OtherSTATE