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NPI Code Detail

MEDICARE: MR. KENT LONG OTR/L

MEDICARE: MR. KENT LONG OTR/L
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
1225X00000XOccupational TherapistOC008463PA

General Provider Information

NPI Number : 1467743153
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENT LONG OTR/L
Provider Business Mailing Address
First Line : 951 WASHINGTON AVE
Second Line :
City : TYRONE
State : PA
Zip : 16686-1426
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 951 WASHINGTON AVE
Second Line :
City : TYRONE
State : PA
Zip : 16686-1426
Country : US
Telephone Number : 814-684-0320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2011
Last Update Date : 06/08/2011

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Directions to “ MR. KENT LONG OTR/L” Practice Location

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