Individual
KELLY LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1906 KENWOOD AVE, CHARLOTTE, NC 28205-3646
(704) 726-6349
Mailing address
1906 KENWOOD AVE, CHARLOTTE, NC 28205-3646
(704) 726-6349
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
9864
NC
Other
Enumeration date
10/20/2015
Last updated
10/20/2015
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