Individual
ELLIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
820 LUDLOW RD, BELLEFONTAINE, OH 43311-1898
(937) 593-9060
Mailing address
820 LUDLOW RD, BELLEFONTAINE, OH 43311-1852
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT010583
OHIO
—
Enumeration date
12/18/2019
Last updated
10/17/2022
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