Individual
MISS BERKELEY R RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1133 N 3RD ST, TECUMSEH, NE 68450-2069
(402) 335-3357
Mailing address
4523 PRESCOTT AVE APT 4, LINCOLN, NE 68506-4964
(320) 226-4591
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
856
NE
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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