Provider Demographics
NPI:1336463694
Name:LONG, ANDREA EILEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:EILEEN
Last Name:LONG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 CRESCENT CT W
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-3446
Mailing Address - Country:US
Mailing Address - Phone:610-820-7667
Mailing Address - Fax:610-820-7671
Practice Address - Street 1:3721 CRESCENT CT W
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3446
Practice Address - Country:US
Practice Address - Phone:610-820-7667
Practice Address - Fax:610-820-7671
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011346225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics