Provider Demographics
NPI:1265715031
Name:RUNK, JODI MARIE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:MARIE
Last Name:RUNK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13187 DRYSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-2107
Mailing Address - Country:US
Mailing Address - Phone:814-251-3182
Mailing Address - Fax:
Practice Address - Street 1:6033 BLUE JAY ACRES LN
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16623-6529
Practice Address - Country:US
Practice Address - Phone:814-448-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15540224Z00000X
PAOP000887L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant