Individual
PAMELA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
12 SAFFRIN HILL CT, GLEN CARBON, IL 62034-1561
(314) 877-8754
Mailing address
PO BOX 203, MARYVILLE, IL 62062-0203
(314) 877-8754
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
225XN1300X
Neurorehabilitation Occupational Therapist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
113413
TX
Other
Enumeration date
02/19/2009
Last updated
09/11/2025
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