Individual
RUSSELL LAMAR LOCKE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
1705 JESS PARRISH CT, TITUSVILLE, FL 32796-2158
(321) 269-5720
Mailing address
6511 JUNE DR, COCOA, FL 32926-2326
(321) 333-2068
(321) 877-1027
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA10650
FL
Other
Enumeration date
03/27/2019
Last updated
03/27/2019
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