Individual
MS. KEISHA A RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
675 SEMINOLE AVE NE, SUITE T05, ATLANTA, GA 30307-3408
(404) 575-4000
Mailing address
2780 LANTERN LN, COLLEGE PARK, GA 30349-3860
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002185
GA
Other
Enumeration date
06/26/2007
Last updated
02/08/2008
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