Provider Demographics
NPI:1730303678
Name:LONG, BARBARA MAE (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:MAE
Last Name:LONG
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-3426
Mailing Address - Country:US
Mailing Address - Phone:309-647-9744
Mailing Address - Fax:309-647-4394
Practice Address - Street 1:634 E ASH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2016
Practice Address - Country:US
Practice Address - Phone:309-647-9744
Practice Address - Fax:309-647-4394
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist