Individual
MICHELLE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3650 NW DEVANE ST, LAKE CITY, FL 32055-8730
(386) 758-1811
Mailing address
1388 BITTERBERRY DR, ORANGE PARK, FL 32065-5239
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT24825
FL
Other
Enumeration date
01/19/2024
Last updated
01/19/2024
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