Individual
ASHLEY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
W175 N11117 STONEWOOD DRIVE, SUITE 100, GERMANTOWN, WI 53022
(262) 780-3813
Mailing address
19525 W NORTH AVE, BROOKFIELD, WI 53045-4107
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5649
WI
Other
Enumeration date
03/23/2016
Last updated
06/21/2017
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