Provider Demographics
NPI:1619390812
Name:RUSSELL, ABBEY MARIE (MS, LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ABBEY
Middle Name:MARIE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:MISS
Other - First Name:ABBEY
Other - Middle Name:MARIE
Other - Last Name:PAISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:212 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2804
Mailing Address - Country:US
Mailing Address - Phone:330-351-5547
Mailing Address - Fax:
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:ORTHOPAEDIC ADMIN, 3RD FLOOR
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-379-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19422255A2300X
OHAT.0049062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer