Individual
MRS. MARY BETH RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
4201 LAKE BOONE TRL, SUITE 4, RALEIGH, NC 27607-7512
(919) 781-4434
Mailing address
4201 LAKE BOONE TRL STE 4, RALEIGH, NC 27607-7511
(919) 781-4434
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
7597
NC
Other
Enumeration date
08/04/2010
Last updated
06/23/2011
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