Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1200X | Ergonomics | 2014 | MA |
Y | 225XE1200X | Ergonomics | 2014 | MA |
NPI | 1417921826 |
---|---|
Provider Name | Susanne S Russell |
First Address | Wakefield, MA 01880-2668 |
Second Address | Waltham, MA 02453-2741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 08/07/2007 |