Provider Demographics
NPI:1366718348
Name:RUSSO, AIMEE C (OTR)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:C
Last Name:RUSSO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PARKVIEW TER
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1365
Mailing Address - Country:US
Mailing Address - Phone:732-842-4097
Mailing Address - Fax:
Practice Address - Street 1:108 PARKVIEW TER
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1365
Practice Address - Country:US
Practice Address - Phone:732-842-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00577200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist