Provider Demographics
NPI:1225379092
Name:RUSSELL, SAMANTHA JANE (OT)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JANE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 MCCLELLAN CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5587
Mailing Address - Country:US
Mailing Address - Phone:907-227-2434
Mailing Address - Fax:
Practice Address - Street 1:8801 MCCLELLAN CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5587
Practice Address - Country:US
Practice Address - Phone:907-227-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2553225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist