Individual
JANET M RUSSENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
7540 N 19TH AVE, SUITE 200, PHOENIX, AZ 85021-7967
(188) 887-3422
Mailing address
103 BOBBY REAPER RD, PANGBURN, AR 72121-9771
(501) 728-4799
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR934
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128094721
—
AR
Enumeration date
02/25/2011
Last updated
02/25/2011
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