=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114658283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TOMMI SHEA LONG OTD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2022
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9225 N 3RD ST STE 101
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85020-2469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 160-286-1121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1535 N SCOTTSDALE RD
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85288-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-687-0733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OTH-010067
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------