Individual
KIMBERLY DENISE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
200 W SANTA ANA BLVD, 100, SANTA ANA, CA 92701-4134
(714) 347-0312
Mailing address
2911 W STONYBROOK DR, ANAHEIM, CA 92804-3931
(949) 533-1078
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1649
CA
Other
Enumeration date
05/11/2006
Last updated
06/05/2018
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