Provider Demographics
NPI:1477724722
Name:RUSSELL, JENNY K (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:K
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 TERRY LN
Mailing Address - Street 2:
Mailing Address - City:CORNERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37047-4010
Mailing Address - Country:US
Mailing Address - Phone:931-293-2312
Mailing Address - Fax:
Practice Address - Street 1:210 TERRY LN
Practice Address - Street 2:
Practice Address - City:CORNERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37047-4010
Practice Address - Country:US
Practice Address - Phone:931-293-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT3821225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist