Tyler Russell
Occupational Therapist in Dearborn, MI. Individual provider (NPI-1).
NPI number1548069735
StatusActive
Last updated in NPPESMar 10, 2025
Details
- NPI
- 1548069735
- Entity type
- Individual (NPI-1)
- Name
- Tyler Russell
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 10, 2025
- Certification date
- Mar 10, 2025
- Last updated
- Mar 10, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | – | MI | Yes |
Practice location
22731 Newman St Ste 100bDearborn, MI 48124-2023
Phone 313-791-0616
Mailing address
280 Xavier Cir, Windsor, On, N8n 0j3Windsor, ONTARIO N8N 0J3
Canada
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