Provider Demographics
NPI:1275171928
Name:RUSSELL- TARI, HELEN CLAIRE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:CLAIRE
Last Name:RUSSELL- TARI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:HELEN
Other - Middle Name:C
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:107 TUTTLE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12093-3907
Mailing Address - Country:US
Mailing Address - Phone:607-435-0465
Mailing Address - Fax:
Practice Address - Street 1:42084 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455-2820
Practice Address - Country:US
Practice Address - Phone:845-586-2631
Practice Address - Fax:845-586-1321
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002085-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002085-1OtherNYS DEPARTMENT OF EDUCATION