Provider Demographics
NPI:1659010684
Name:DELONG, PATRICIA LEE (MHS, OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:DELONG
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S CREYTS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8269
Mailing Address - Country:US
Mailing Address - Phone:517-303-9768
Mailing Address - Fax:
Practice Address - Street 1:616 S CREYTS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8269
Practice Address - Country:US
Practice Address - Phone:517-303-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005255225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201005255OtherSTATE OF MICHIGAN BOARD OF OCCUPATIONAL THERAPISTS