Individual
KYLIE ANN LONGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1600 3RD AVE, LONGVIEW, WA 98632-3231
(360) 425-9810
(360) 425-1053
Mailing address
1600 3RD AVE, LONGVIEW, WA 98632-3231
(360) 425-9810
(360) 425-1053
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OC 60345231
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7018088
—
WA
Enumeration date
04/12/2013
Last updated
04/12/2013
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