MEDICARE: CARMEN MARIA LONGNECKER OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist	OT12625	FL
2	225X00000X	Occupational Therapist	OT12625	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467570648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN MARIA LONGNECKER OTRL

Provider Business Mailing Address
First Line	:	10218 MILLPORT DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1704
Country	:	US
Telephone Number	:	813-778-1368
Fax Number	:

Provider Business Practice Location Address
First Line	:	10218 MILLPORT DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1704
Country	:	US
Telephone Number	:	813-778-1368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	03/02/2021

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