Individual
AMANDA JEAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
125 ISLAND DR, HENDERSONVILLE, TN 37075-4544
(615) 714-9224
Mailing address
125 ISLAND DR, HENDERSONVILLE, TN 37075-4544
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4624
TN
Other
Enumeration date
07/26/2012
Last updated
07/26/2012
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