MEDICARE: TERRI RUNSER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OP007149	PA

General Provider Information

NPI Number	:	1568857381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI RUNSER

Provider Business Mailing Address
First Line	:	10339 LAKE PLEASANT RD
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441-2533
Country	:	US
Telephone Number	:	814-825-8309
Fax Number	:

Provider Business Practice Location Address
First Line	:	10339 LAKE PLEASANT RD
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441-2533
Country	:	US
Telephone Number	:	814-825-8309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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Directions to “ TERRI RUNSER ” Practice Location

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