Provider Demographics
NPI:1982037545
Name:LONG, CHELSEY RENEE (AT)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:RENEE
Last Name:LONG
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 SUGAR GROVE RD SE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4858
Mailing Address - Country:US
Mailing Address - Phone:740-215-6255
Mailing Address - Fax:
Practice Address - Street 1:1136 SUGAR GROVE RD SE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4858
Practice Address - Country:US
Practice Address - Phone:740-215-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0040832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer