Individual
HOLLY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR
Contact information
Practice address
10320 N NEW JERSEY ST, INDIANAPOLIS, IN 46280-1360
(317) 413-5778
Mailing address
10320 N NEW JERSEY ST, INDIANAPOLIS, IN 46280-1360
(317) 413-5778
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
06720
MD
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
31003599A
IN
Other
Enumeration date
09/28/2011
Last updated
09/28/2011
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