Provider Demographics
NPI:1417546516
Name:LONG, SARAH KRISTINA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISTINA
Last Name:LONG
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 CHEEKS LN
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-4236
Mailing Address - Country:US
Mailing Address - Phone:336-675-2207
Mailing Address - Fax:
Practice Address - Street 1:1617 ONSLOW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3567
Practice Address - Country:US
Practice Address - Phone:704-931-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13774225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist