Provider Demographics
NPI:1396878641
Name:RUSSELL, MARGARET (MED,OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MED,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 LANDSCAPE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4247
Mailing Address - Country:US
Mailing Address - Phone:314-962-6964
Mailing Address - Fax:
Practice Address - Street 1:701 LANDSCAPE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4247
Practice Address - Country:US
Practice Address - Phone:314-962-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004548225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist