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General NPI Number Information
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NPI Number | 1154793610
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Entity Type | Individual
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Provider Name | KAREN RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 200 LEEDER HILL DR
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City | HAMDEN
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State | CT
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Zip | 06517-2758
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Country | US
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Telephone | 860-848-2631
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Fax |
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Provider Business Mailing Address
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Address Line | 41 CENTRAL AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2702
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 001217
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License Number State | CT
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