Individual
KATELYN ANN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
620 WARRINGTON AVE, DANVILLE, IL 61832-5446
(217) 446-0660
(217) 446-9839
Mailing address
2251 W STONE BLUFF RD, COVINGTON, IN 47932-8103
(217) 504-2565
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003857
IL
Other
Enumeration date
01/29/2018
Last updated
01/29/2018
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