Individual
SHANNON RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
Mailing address
2930 MARKBREIT AVE APT 4, CINCINNATI, OH 45209-2000
(717) 552-1973
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
07/18/2023
Last updated
07/18/2023
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