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NPI Code Detail

MEDICARE: ABIGAIL RUSSO OTR/L

MEDICARE: ABIGAIL RUSSO 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
1225X00000XOccupational Therapist0006627CO

General Provider Information

NPI Number : 1912598962
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL RUSSO OTR/L
Provider Business Mailing Address
First Line : 3358 ASTORBROOK WAY
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80126-7812
Country : US
Telephone Number : 814-771-7637
Fax Number :
Provider Business Practice Location Address
First Line : 8101 E MISSISSIPPI AVE
Second Line :
City : DENVER
State : CO
Zip : 80247-1104
Country : US
Telephone Number : 303-337-3400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2021
Last Update Date : 06/30/2022

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