Individual
MS. DIANE MARIE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
36 VIOLET AVE, MINEOLA, NY 11501-4624
(516) 742-8138
(516) 742-8138
Mailing address
36 VIOLET AVE, MINEOLA, NY 11501-4624
(516) 742-8138
(516) 742-8138
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
002521-1
NY
Other
Enumeration date
01/07/2009
Last updated
01/07/2009
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