Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT006648 | OH |
NPI | 1023585544 |
---|---|
Provider Name | Russell Garrison |
First Address | Cincinnati, OH 45229-2833 |
Second Address | Cincinnati, OH 45229-2833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2018 |
Last Update Date | 02/11/2018 |