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NPI Code Detail

MEDICARE: KAITLYN NICOLE RUSSELL MS, OTR/L

MEDICARE: KAITLYN NICOLE RUSSELL MS, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist027543NY

General Provider Information

NPI Number : 1255039384
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN NICOLE RUSSELL MS, OTR/L
Provider Business Mailing Address
First Line : 367 BILLS RD
Second Line :
City : MACEDON
State : NY
Zip : 14502-9334
Country : US
Telephone Number : 585-626-8851
Fax Number :
Provider Business Practice Location Address
First Line : 2099 W RIDGE RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14626-2728
Country : US
Telephone Number : 315-437-4689
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2023
Last Update Date : 02/17/2023

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