Individual
MRS. SHANNON L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
4154 LOMAC ST, MONTGOMERY, AL 36106-2815
(334) 262-5744
(334) 262-5155
Mailing address
4154 LOMAC ST, MONTGOMERY, AL 36106-2815
(334) 262-5744
(334) 262-5155
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
005110
AL
Other
Enumeration date
08/29/2007
Last updated
08/30/2007
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