Individual
MR. MARK JOSEPH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
275 EAST MAIN STREET, FRANKFORT, KY 40621-0001
(502) 564-3756
Mailing address
275 EAST MAIN STREET, FRANKFORT, KY 40621-0001
(502) 564-3756
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
R-2326
KY
Other
Enumeration date
11/19/2012
Last updated
11/19/2012
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