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1730599226
EDWARD JOHN RUSSELL
MESA, AZ
NPI
1730599226
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: AZ 5776)
Enumeration Date
2014-05-06
Last Update Date
2014-05-06
Business Address
MR. EDWARD JOHN RUSSELL COTAL
5358 E BASELINE RD
MESA, AZ 85206-4716
Phone number: 480-630-3005
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Mailing Address
MR. EDWARD JOHN RUSSELL COTAL
25117 SW PARKWAY AVE STE D
WILSONVILLE, OR 97070-9697
Phone number:
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