1275171928 NPI number — MRS. HELEN CLAIRE RUSSELL- TARI OTR/L

Table of content: MRS. HELEN CLAIRE RUSSELL- TARI OTR/L (NPI 1275171928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275171928 NPI number — MRS. HELEN CLAIRE RUSSELL- TARI OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL- TARI
Provider First Name:
HELEN
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUSSELL
Provider Other First Name:
HELEN
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275171928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 TUTTLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12093-3907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-435-0465
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42084 STATE HIGHWAY 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGARETVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12455-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-586-2631
Provider Business Practice Location Address Fax Number:
845-586-1321
Provider Enumeration Date:
12/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  002085-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002085-1 . This is a "NYS DEPARTMENT OF EDUCATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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