Individual
MR. RUSSELL JOHN PHILLIPPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.O.T.A.
Contact information
Practice address
407 E 106TH ST, INDIANAPOLIS, IN 46280-1325
(317) 460-3493
Mailing address
407 E 106TH ST, INDIANAPOLIS, IN 46280-1325
(317) 460-3493
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000325A
IN
Other
Enumeration date
08/19/2008
Last updated
08/19/2008
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