Individual
CARMEN MARIA LONGNECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
10218 MILLPORT DR, TAMPA, FL 33626-1704
(813) 778-1368
Mailing address
10218 MILLPORT DR, TAMPA, FL 33626-1704
(813) 778-1368
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
OT12625
FL
225X00000X
Occupational Therapist
Primary
OT12625
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
892038900
—
FL
Enumeration date
03/27/2007
Last updated
03/02/2021
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