Individual
AMANDA RAE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9350 GREEN PARK RD, SAINT LOUIS, MO 63123-7211
(413) 845-0900
Mailing address
1607 ORIOLE LN, BRENTWOOD, MO 63144-1110
(314) 496-9344
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2018032994
MO
Other
Enumeration date
06/12/2022
Last updated
06/12/2022
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