Individual
MS. ELIZABETH RUSSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, OTR/L
Contact information
Practice address
311 S SPRING ST, SUITE 01-11, LOS ANGELES, CA 90013-1211
(213) 897-6345
(213) 897-2882
Mailing address
1923 W PARKSIDE AVE, BURBANK, CA 91506-2910
(818) 841-0997
(818) 841-0997
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
BOT 295
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMS 165416
CHILDREN'S MEDICAL SERVIC
CA
01
—
CTO 002950
MEDI-CAL NUMBER
CA
01
—
OT 295
BOARD OF OCCUPATIONAL THE
CA
Enumeration date
10/11/2006
Last updated
07/08/2007
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