Provider Demographics
NPI:1437311164
Name:DE LONG, MEGAN N (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:N
Last Name:DE LONG
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 POWDER HOUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1624
Mailing Address - Country:US
Mailing Address - Phone:617-448-8893
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST
Practice Address - Street 2:EASTER SEALS MASSACHUSETTS
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:800-244-2756
Practice Address - Fax:508-831-9768
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist