Individual
ANNA LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
4460 18TH ST, WYANDOTTE, MI 48192-6925
(734) 759-6401
Mailing address
6988 MCKEAN RD LOT 102, YPSILANTI, MI 48197-9797
(330) 546-5678
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201010390
MI
Other
Enumeration date
01/08/2019
Last updated
01/08/2019
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