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Individual

MR. LAWRENCE JULIAN RUSSELL JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
COTA/L

Contact information

Practice address
1500 PALM BEACH RD, STUART, FL 34994-4044
(772) 288-1860
(772) 781-6731
Mailing address
PO BOX 1362, JUPITER, FL 33468-1362
(561) 222-3140

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA8234
FL

Other

Enumeration date
02/11/2010
Last updated
02/11/2010
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