Russell, Jennifer

Russell, Jennifer is an sole proprietor health care provider with primary practice located at 6804 Sanger Ave #227, Waco TX 76710-4257. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant, which is considered as her primary health care specialty. Russell, Jennifer can be contacted via phone (800) 340-4098.

Contact Information

Primary practice address
6804 Sanger Ave #227 Waco TX 76710-4257
Phone: (800) 340-4098
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant 224Z00000X 403816 Texas

Profile Details

NPI number 1497065577
LBN Legal business name Russell, Jennifer
Credentials Certified Occupational Therapy Assistant (COTA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 7th, 2010
Last updated Oct 7th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497065577 NPPES
Texas MEDICAID 207164901
Texas MEDICAID 149984001

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