Provider Demographics
NPI:1780752089
Name:RUNYON, ANNETTE K (ORT,CHT)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:K
Last Name:RUNYON
Suffix:
Gender:F
Credentials:ORT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641268
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0304
Mailing Address - Country:US
Mailing Address - Phone:270-745-1120
Mailing Address - Fax:270-745-1156
Practice Address - Street 1:1110 WILKINSON TRCE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3402
Practice Address - Country:US
Practice Address - Phone:270-796-6850
Practice Address - Fax:270-781-8228
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251H1200X
KYR1813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1760411342OtherGROUP NPI
KYGROUP #91011148Medicaid
KY1760411342OtherGROUP NPI