Individual
MARY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Contact information
Practice address
10 KRUGER RD, PLAINS, MT 59859-9271
(406) 493-5602
Mailing address
PO BOX 1658, PLAINS, MT 59859-1658
(406) 493-5602
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1065
MT
Other
Enumeration date
01/19/2010
Last updated
01/19/2010
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