Individual
AMBER RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5050 VILLAGE SQUARE DR STE B, PADUCAH, KY 42001-9499
(270) 443-0681
(270) 442-7948
Mailing address
5050 VILLAGE SQUARE DR STE B, PADUCAH, KY 42001-9499
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A4362
KY
Other
Enumeration date
05/04/2010
Last updated
05/04/2010
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