Individual
AMANDA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
368 LAKEHURST RD, TOMS RIVER, NJ 08755-7339
(888) 244-5373
Mailing address
368 LAKEHURST RD, TOMS RIVER, NJ 08755-7339
(888) 244-5373
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
10/24/2018
Last updated
10/24/2018
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