Individual
BECKY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
153 BROWN RD, MANGHAM, LA 71259-5144
(318) 791-6169
Mailing address
153 BROWN RD, MANGHAM, LA 71259-5144
(318) 791-6169
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
LA20253
LA
Other
Enumeration date
05/17/2007
Last updated
05/21/2020
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