Provider Demographics
NPI:1043308166
Name:RUSSELL, RACHEL CELESE (MOT OTR L)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:CELESE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MOT OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 COLLINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013
Mailing Address - Country:US
Mailing Address - Phone:214-707-8557
Mailing Address - Fax:615-333-9015
Practice Address - Street 1:300 STONE CREST PKWY
Practice Address - Street 2:STE 375
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-220-5796
Practice Address - Fax:615-220-8829
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3484225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist