Provider Demographics
NPI:1710757901
Name:LONG, PATRICK CHRISTOPHER (OTD, OT/L)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:CHRISTOPHER
Last Name:LONG
Suffix:
Gender:M
Credentials:OTD, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WILKINSON PASS LN APT 105
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-8932
Mailing Address - Country:US
Mailing Address - Phone:423-534-9220
Mailing Address - Fax:
Practice Address - Street 1:68 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2722
Practice Address - Country:US
Practice Address - Phone:828-586-7235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119010189225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation