Provider Demographics
NPI:1497928378
Name:LONG, PATRICIA LEONA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEONA
Last Name:LONG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:FEATHER
Other - Middle Name:
Other - Last Name:LATHERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:151 GREENLEA DR
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2647
Mailing Address - Country:US
Mailing Address - Phone:412-269-0671
Mailing Address - Fax:412-474-3575
Practice Address - Street 1:890 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2653
Practice Address - Country:US
Practice Address - Phone:412-474-3566
Practice Address - Fax:412-474-3575
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497928378OtherNOT SURE WORK WITH EARLY INTERVENTION AND CHILDREN IN CLINIC SETTINGS.