Individual
MRS. KIMBERLY MICHELE RUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
8532 CANTERBURY LAKE BLVD, TAMPA, FL 33619-6674
(813) 389-3229
Mailing address
8532 CANTERBURY LAKE BLVD, TAMPA, FL 33619-6674
(813) 389-3229
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/13/2011
Last updated
06/14/2011
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