Provider Demographics
NPI:1851637995
Name:RUNKLE, JULIA MARIAH (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MARIAH
Last Name:RUNKLE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MARIAH
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR
Mailing Address - Street 1:9150 W INDIAN SCHOOL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2388
Mailing Address - Country:US
Mailing Address - Phone:480-787-5387
Mailing Address - Fax:623-232-3250
Practice Address - Street 1:9150 W INDIAN SCHOOL RD STE 130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2388
Practice Address - Country:US
Practice Address - Phone:480-787-5387
Practice Address - Fax:623-232-3250
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-009651225X00000X
CO003573225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ179429Medicaid
CO0003573OtherSTATE