Healthcare Provider Details

I. General information

NPI: 1114658283
Provider Name (Legal Business Name): TOMMI SHEA LONG OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 N 3RD ST STE 101
PHOENIX AZ
85020-2469
US

IV. Provider business mailing address

1535 N SCOTTSDALE RD
TEMPE AZ
85288-1500
US

V. Phone/Fax

Practice location:
  • Phone: 160-286-1121
  • Fax:
Mailing address:
  • Phone: 808-687-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-010067
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: