Individual
ANTUANETTE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 YATES ST, TOLEDO, OH 43608-2558
(419) 819-2726
Mailing address
1320 YATES ST, TOLEDO, OH 43608-2558
(419) 819-2726
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
—
—
374700000X
Technician
Primary
—
—
Other
Enumeration date
09/05/2025
Last updated
12/01/2025
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