Individual
MRS. JUDITH ANN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/C
Contact information
Practice address
2495 MAIN ST, SUITE 234, BUFFALO, NY 14214-2152
(716) 836-5929
(716) 836-6057
Mailing address
67 JACKSON AVE, NORTH TONAWANDA, NY 14120-2603
(716) 692-1801
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005258-1
NY
Other
Enumeration date
01/18/2011
Last updated
01/18/2011
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