Individual
DR. KIMBERLY KD RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1812 N SPUALDING AVE, CHICAGO, IL 60647
(312) 965-7633
Mailing address
1812 N SPUALDING AVE, CHICAGO, IL 60647
(312) 965-7633
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056008127
IL
Other
Enumeration date
10/31/2007
Last updated
09/12/2012
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