Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT7361 | FL |
NPI | 1174747398 |
---|---|
Provider Name | Mrs. Tish Lee Long |
First Address | Lake Mary, FL 32746-1402 |
Second Address | Lake Mary, FL 32746-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 03/02/2020 |