Individual
MICHAELA CORNFORTH LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 791-2000
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5365
SC
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
09/21/2018
Last updated
12/15/2023
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