Provider Demographics
NPI:1255755468
Name:TUZON LONG, JACQUELINE CARIDAD (MS OTR/L)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:CARIDAD
Last Name:TUZON LONG
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:CARIDAD
Other - Last Name:TUZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 CARTRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7684
Mailing Address - Country:US
Mailing Address - Phone:843-343-2007
Mailing Address - Fax:
Practice Address - Street 1:142 CARTRIGHT ST
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7684
Practice Address - Country:US
Practice Address - Phone:843-343-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist