Individual
MALLORIE RACHELLE RUNYARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5833 AMERICAN PKWY, MADISON, WI 53718-8325
(608) 230-4681
(608) 230-4680
Mailing address
5833 AMERICAN PKWY, MADISON, WI 53718-8325
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
241087
NBCOT
—
01
—
4627-27
COTA
WI
Enumeration date
12/08/2017
Last updated
12/08/2017
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