Provider Demographics
NPI:1083385561
Name:RUSSELL, LINETTE JACQUELINE
Entity type:Individual
Prefix:
First Name:LINETTE
Middle Name:JACQUELINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:READFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04355-3000
Mailing Address - Country:US
Mailing Address - Phone:207-513-2156
Mailing Address - Fax:
Practice Address - Street 1:9 GREEN ST STE 306
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7411
Practice Address - Country:US
Practice Address - Phone:207-802-0788
Practice Address - Fax:888-388-2696
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5617225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty