Individual
LISA MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
725 COLUMBUS AVE, FOSTORIA, OH 44830-3255
(419) 937-1801
Mailing address
725 COLUMBUS AVE, FOSTORIA, OH 44830-3255
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA006781
OH
Other
Enumeration date
12/31/2018
Last updated
12/31/2018
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