# RUSSO REHABILITATION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902180573
- **Authorized official:** KELLY RUSSO STONE OTR/L (CEO; OWNER; OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (678) 462-2923

## Contact information

- **Practice address:** 505 LOUVOIS ST, MANDEVILLE, LA 70448-5468
- **Practice address phone:** (678) 462-2923
- **Practice address fax:** (866) 753-4652
- **Mailing address:** 505 LOUVOIS ST, MANDEVILLE, LA 70448-5468
- **Mailing address phone:** (678) 462-2923
- **Mailing address fax:** (866) 753-4652

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 225XN1300X | Neurorehabilitation Occupational Therapist | — | — | Yes |
| 225XP0200X | Pediatric Occupational Therapist | — | NULL | — |
| 225XP0200X | Pediatric Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 09/30/2011
- **Last updated:** 06/20/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2450514 | — | LA |