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General NPI Number Information
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NPI Number | 1720310147
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Entity Type | Individual
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Provider Name | JACQUI LONG MS,OTR/L, CHT
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Gender | Female
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 6410 ROCKLEDGE DR STE 600
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City | BETHESDA
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State | MD
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Zip | 20817-1844
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Country | US
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Telephone | 301-581-8030
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 PARK RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28209-2290
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Country | US
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Telephone | 704-323-2276
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Fax | 704-945-7681
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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 | 10443
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License Number State | NC
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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 | OT15730
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License Number State | FL
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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 | 116098
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201010649
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC011331
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License Number State | PA
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