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General NPI Number Information
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NPI Number | 1194418483
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Entity Type | Individual
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Provider Name | COURTNEY D LONG OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 120 COLEMANS CROSSING BLVD
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City | MARYSVILLE
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State | OH
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Zip | 43040-7115
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Country | US
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Telephone | 937-578-7841
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Fax | 937-578-7891
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Provider Business Mailing Address
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Address Line | 500 LONDON AVE
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City | MARYSVILLE
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State | OH
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Zip | 43040-3570
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Country | US
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Telephone | 937-644-6115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 32003385A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31008185A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT012695
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License Number State | OH
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