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NPI Code Detail

MEDICARE: ELISE LONG OTR/L

MEDICARE: ELISE 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 Therapist105039MN

General Provider Information

NPI Number : 1912365743
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISE LONG OTR/L
Provider Business Mailing Address
First Line : 8140 RED OAK CT
Second Line :
City : SAINT PAUL
State : MN
Zip : 55112-5843
Country : US
Telephone Number : 515-745-3171
Fax Number :
Provider Business Practice Location Address
First Line : 1250 W BROADWAY AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2533
Country : US
Telephone Number : 612-668-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2016
Last Update Date : 12/08/2025

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