Provider Demographics
NPI:1437218294
Name:LONG, FAY E (OTR)
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:E
Last Name:LONG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:FAY
Other - Middle Name:E
Other - Last Name:SZYSZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:989 W MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-1759
Mailing Address - Country:US
Mailing Address - Phone:414-486-6237
Mailing Address - Fax:
Practice Address - Street 1:10233 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3911
Practice Address - Country:US
Practice Address - Phone:414-791-0813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1315-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist