Individual
ASHLEY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 COLLEGE BLVD E, NICEVILLE, FL 32578-1343
(850) 279-3000
(850) 389-2269
Mailing address
80 COLLEGE BLVD E, NICEVILLE, FL 32578-1343
(850) 279-3000
(850) 389-2269
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
21-174813
FL
225X00000X
Occupational Therapist
Primary
4301
AL
Other
Enumeration date
07/09/2021
Last updated
11/27/2023
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