Individual
MRS. LORI LYNN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
W143N5009 BROOK FALLS DR, MENOMONEE FALLS, WI 53051-6987
(262) 781-8352
Mailing address
1680 BERKSHIRE DR, ELM GROVE, WI 53122-1502
(414) 529-9982
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3208-026
WI
Other
Enumeration date
01/09/2008
Last updated
01/09/2008
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