Individual
CARISSA LEIGH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
28080 LEMOYNE RD, MILLBURY, OH 43447-9747
(419) 279-3794
Mailing address
2801 S MAIN ST APT D4, FINDLAY, OH 45840-1055
(989) 430-9977
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
OH
Other
Enumeration date
04/25/2020
Last updated
04/25/2020
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