Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1013276146 |
---|---|
Provider Name | Danielle Denise Long |
First Address | Mableton, GA 30126-2654 |
Second Address | Mableton, GA 30126-2654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2012 |
Last Update Date | 26/11/2019 |