Individual
ANITA C RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26 SHENIPSIT LAKE RD, TOLLAND, CT 06084-2332
(860) 872-2999
Mailing address
26 SHENIPSIT LAKE RD, TOLLAND, CT 06084-2332
(860) 872-2999
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
003931
CT
Other
Enumeration date
07/11/2012
Last updated
07/11/2012
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