Individual
MRS. TIFFANY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
7600 AUTUMN PARK WAY, MECHANICSVILLE, VA 23116-3868
(804) 730-0009
Mailing address
7600 AUTUMN PARK WAY, MECHANICSVILLE, VA 23116-3868
(804) 730-0009
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119004900
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119004900
LICENSE NUMBER
VA
Enumeration date
07/20/2011
Last updated
05/16/2016
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