Provider Demographics
NPI:1396250072
Name:LONGLEY, OLIVIA O (OTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:O
Last Name:LONGLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-6034
Mailing Address - Country:US
Mailing Address - Phone:860-305-2389
Mailing Address - Fax:
Practice Address - Street 1:18 PLEASANT RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-6034
Practice Address - Country:US
Practice Address - Phone:860-305-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT094317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist