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Organization
RUSSO REHABILITATION, LLC
Active
Organization
RUSSO REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY RUSSO STONE OTR/L (CEO; OWNER; OCCUPATIONAL THERAPIST)
(678) 462-2923
Entity
Organization
Contact information
Practice address
505 LOUVOIS ST, MANDEVILLE, LA 70448-5468
(678) 462-2923
(866) 753-4652
Mailing address
505 LOUVOIS ST, MANDEVILLE, LA 70448-5468
(678) 462-2923
(866) 753-4652
Taxonomy
Speciality
Code
Description
License number
State
225XE0001X
Environmental Modification Occupational Therapist
—
NULL
225XE0001X
Environmental Modification Occupational Therapist
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
NULL
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
225XM0800X
Mental Health Occupational Therapist
—
NULL
225XM0800X
Mental Health Occupational Therapist
—
—
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
—
NULL
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
—
NULL
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2450514
—
LA
Enumeration date
09/30/2011
Last updated
06/20/2023
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