Individual
SAMANTHA L RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
10435 MIDTOWN PKWY, UNIT 152, JACKSONVILLE, FL 32246-7483
(772) 621-0183
Mailing address
10435 MIDTOWN PKWY, UNIT 152, JACKSONVILLE, FL 32246-7483
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT15232
FL
Other
Enumeration date
09/03/2014
Last updated
09/03/2014
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