Individual
KRISTIE SMITH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2120 MARSHALL EDWARDS DR, BARTOW, FL 33830-6731
(863) 534-1862
(863) 619-6059
Mailing address
980 E CHURCH ST, BLDG A 102, BARTOW, FL 33830-4104
(863) 677-4605
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA11145
FL
Other
Enumeration date
05/20/2010
Last updated
05/20/2010
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