Provider Demographics
NPI:1225126394
Name:RUSSEL, ELIZABETH (PHD, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:RUSSEL
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 W PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2910
Mailing Address - Country:US
Mailing Address - Phone:818-841-0997
Mailing Address - Fax:818-841-0997
Practice Address - Street 1:311 S SPRING ST
Practice Address - Street 2:SUITE 01-11
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1211
Practice Address - Country:US
Practice Address - Phone:213-897-6345
Practice Address - Fax:213-897-2882
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
CABOT 295225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACTO 002950OtherMEDI-CAL NUMBER
CACMS 165416OtherCHILDREN'S MEDICAL SERVIC
CAOT 295OtherBOARD OF OCCUPATIONAL THE