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General NPI Number Information
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NPI Number | 1083385561
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Entity Type | Individual
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Provider Name | LINETTE JACQUELINE RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 9 GREEN ST STE 306
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City | AUGUSTA
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State | ME
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Zip | 04330-7411
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Country | US
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Telephone | 207-802-0788
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Fax | 888-388-2696
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Provider Business Mailing Address
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Address Line | 75 MAIN ST
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City | READFIELD
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State | ME
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Zip | 04355-3000
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Country | US
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Telephone | 207-513-2156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT5617
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License Number State | ME
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