Provider Demographics
NPI:1982313136
Name:LONGO, DEANNA MARION (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARION
Last Name:LONGO
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 1:5 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4202
Mailing Address - Country:US
Mailing Address - Phone:516-404-5973
Mailing Address - Fax:
Practice Address - Street 1:144 E 128TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1329
Practice Address - Country:US
Practice Address - Phone:212-369-2227
Practice Address - Fax:212-427-6608
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist