Provider Demographics
NPI:1912243254
Name:RUSSELL, ERIN (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 STATE ROUTE 13 NE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9777
Mailing Address - Country:US
Mailing Address - Phone:740-621-1656
Mailing Address - Fax:
Practice Address - Street 1:8205 STATE ROUTE 13 NE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783-9777
Practice Address - Country:US
Practice Address - Phone:740-621-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05194224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant