Individual
JAMIE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
206 MARYLAND AVE, MCCOMB, MS 39648-3926
(601) 250-4815
Mailing address
2440 LITTLE BLACK CREEK RD, LUMBERTON, MS 39455-7881
(601) 520-4943
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1245
MS
Other
Enumeration date
04/18/2008
Last updated
04/18/2008
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