Individual
MARY KATHLEEN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Contact information
Practice address
3775 COUNTRY LN, BROWNSBURG, IN 46112-8375
(317) 858-9828
Mailing address
3775 COUNTRY LN, BROWNSBURG, IN 46112-8375
(317) 858-9828
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
31003367A
IN
Other
Enumeration date
09/04/2009
Last updated
09/04/2009
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