Individual
LAURA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1221 BROAD ST, FUQUAY VARINA, NC 27526-3602
(800) 552-0213
Mailing address
188 SUSAN DR, GARNER, NC 27529-9211
(919) 987-0896
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
7764
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41058500
—
WI
Enumeration date
01/02/2008
Last updated
01/13/2015
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