Individual
SHELLEY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
39210 LIVE OAK DR, PONCHATOULA, LA 70454-6664
(985) 510-0282
Mailing address
39210 LIVE OAK DR, PONCHATOULA, LA 70454-6664
(985) 510-0282
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3637
AL
225XP0200X
Pediatric Occupational Therapist
OTT.Z12304
LA
Other
Enumeration date
03/13/2017
Last updated
03/02/2023
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