Provider Demographics
NPI:1215656624
Name:RUSSELL, JENNIFER M (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 CHESNEY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8140
Mailing Address - Country:US
Mailing Address - Phone:859-630-3705
Mailing Address - Fax:
Practice Address - Street 1:1825 CHESNEY DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8140
Practice Address - Country:US
Practice Address - Phone:859-630-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist