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Individual

STACIE RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
1049 N EDGE TRL, VERONA, WI 53593-1942
(608) 845-2100
Mailing address
3022 ACKER ST, CROSS PLAINS, WI 53528-9557
(608) 438-2903

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
WI

Other

Enumeration date
10/16/2019
Last updated
10/16/2019
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