Healthcare Provider Details

I. General information

NPI: 1699698183
Provider Name (Legal Business Name): ABIGAIL RUSSELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PROFESSIONAL PL
GREENWOOD MS
38930-2756
US

IV. Provider business mailing address

103 PROFESSIONAL PL
GREENWOOD MS
38930-2756
US

V. Phone/Fax

Practice location:
  • Phone: 662-477-0716
  • Fax: 662-477-0717
Mailing address:
  • Phone: 662-477-0716
  • Fax: 662-477-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1746
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: