Individual
KIRSTEN RUNNALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, MS, OTR/L
Contact information
Practice address
5219 88TH AVE, KENOSHA, WI 53144-7468
(262) 653-0850
Mailing address
5219 88TH AVE, KENOSHA, WI 53144-7468
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5601-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
560126
—
WI
Enumeration date
03/25/2015
Last updated
03/25/2015
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