Healthcare Provider Details

I. General information

NPI: 1225388978
Provider Name (Legal Business Name): SARAH MARGARET RUSSELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CENTENNIAL DR
CHADRON NE
69337-9400
US

IV. Provider business mailing address

825 CENTENNIAL DR
CHADRON NE
69337-9400
US

V. Phone/Fax

Practice location:
  • Phone: 308-432-0232
  • Fax: 308-430-0268
Mailing address:
  • Phone: 308-432-0232
  • Fax: 308-432-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1061
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: