Individual
JESSICA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
302 SADIE DOUGLAS CIR, SHREVEPORT, LA 71106-7689
(318) 465-3743
Mailing address
302 SADIE DOUGLAS CIR, SHREVEPORT, LA 71106-7689
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.Z11253
LA
Other
Enumeration date
06/29/2015
Last updated
06/29/2015
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