Healthcare Provider Details

I. General information

NPI: 1932033263
Provider Name (Legal Business Name): MAGEN RUNNELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 PETERMAN DR
ALEXANDRIA LA
71301-3432
US

IV. Provider business mailing address

1440 PETERMAN DR
ALEXANDRIA LA
71301-3432
US

V. Phone/Fax

Practice location:
  • Phone: 318-278-0740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number350166
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: