Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1912421827 |
---|---|
Provider Name | Katherine Long |
First Address | Milwaukie, OR 97222-5944 |
Second Address | Vancouver, WA 98664-1980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2017 |
Last Update Date | 17/03/2018 |