Individual
JACOB A RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 13TH AVE, BELLE FOURCHE, SD 57717-2215
(605) 892-3331
Mailing address
4713 GLANSTONBURY DR, HILLIARD, OH 43026-8654
(614) 592-4670
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
01/24/2023
Last updated
01/24/2023
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