Individual
MRS. ANGIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
620 N ALLEGHANEY AVE, ODESSA, TX 79761-4408
(432) 332-8244
(432) 580-7428
Mailing address
4206 GREENBRIAR DR, MIDLAND, TX 79707-5423
(432) 262-1004
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
105493
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105493
STATE LICENSE NUMBER
TX
01
—
8T4670
BCBS PROVIDER NUMBER
TX
Enumeration date
03/13/2007
Last updated
07/08/2007
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