Provider Demographics
NPI:1386920494
Name:KOLI, RUNA (OTR)
Entity type:Individual
Prefix:
First Name:RUNA
Middle Name:
Last Name:KOLI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREENE ST
Mailing Address - Street 2:109
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4545
Mailing Address - Country:US
Mailing Address - Phone:646-821-3683
Mailing Address - Fax:
Practice Address - Street 1:150 BELLE MEADE PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3813
Practice Address - Country:US
Practice Address - Phone:925-828-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00483400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist