Individual
KIELLY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4351 SYCAMORE CREEK DR, BLUE ASH, OH 45242-3410
(513) 401-8855
Mailing address
8177 FOX KNOLL DR, WEST CHESTER, OH 45069-2898
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
10631
OH
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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