Individual
LA' SHANDRA HOLMES-RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
15 ELM ST, STAFFORD, VA 22554-1607
(401) 326-4739
Mailing address
15 ELM ST, STAFFORD, VA 22554-1607
(401) 326-4739
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119008569
VA
Other
Enumeration date
03/26/2020
Last updated
03/26/2020
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