Provider Demographics
NPI:1508001454
Name:LONG, DENISE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
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 1:54 PAUMANAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1910
Mailing Address - Country:US
Mailing Address - Phone:516-819-8122
Mailing Address - Fax:631-983-8488
Practice Address - Street 1:54 PAUMANAKE AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1910
Practice Address - Country:US
Practice Address - Phone:516-819-8122
Practice Address - Fax:631-983-8488
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011464225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics