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General NPI Number Information
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NPI Number | 1578696118
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Entity Type | Individual
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Provider Name | ANGIE LONG OTR
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 620 N ALLEGHANEY AVE
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City | ODESSA
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State | TX
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Zip | 79761-4408
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Country | US
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Telephone | 432-332-8244
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Fax | 432-580-7428
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Provider Business Mailing Address
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Address Line | 4206 GREENBRIAR DR
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City | MIDLAND
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State | TX
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Zip | 79707-5423
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Country | US
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Telephone | 432-262-1004
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 105493
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License Number State | TX
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