Individual
THOMAS LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5908 COBBLESTONE CREEK CIR, MABLETON, GA 30126-2654
(931) 241-1159
Mailing address
5908 COBBLESTONE CREEK CIR, MABLETON, GA 30126-2654
(931) 241-1159
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005651
GA
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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