Active NPI
Amanda Lee Russell
- Occupational Therapy Assistant
- Ballston Spa, NY
National Provider Identifier
1750859328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 004337-1
- Practice address
- 87 Division St
Ballston Spa, NY 12020-1006 - Phone
- (518) 885-2951
- NPI assigned
- Nov 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 004337-1 | NY | Primary |
Addresses
Primary practice location
87 Division St
Ballston Spa, NY 12020-1006
Mailing address
87 Division St
Ballston Spa, NY 12020-1006
Phone (518) 885-2951
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004337-1 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541980800000",
"number": "1750859328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "87 DIVISION ST",
"city": "BALLSTON SPA",
"state": "NY",
"postal_code": "120201006",
"telephone_number": "518-885-2951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "87 DIVISION ST",
"city": "BALLSTON SPA",
"state": "NY",
"postal_code": "120201006",
"telephone_number": "518-885-2951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "AMANDA",
"middle_name": "LEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-12",
"last_updated": "2018-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "004337-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ballston Spa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.