Individual
NATHAN D LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
564 S WOODRUFF AVE, IDAHO FALLS, ID 83401
(208) 523-7571
(208) 523-7573
Mailing address
564 S WOODRUFF AVE, IDAHO FALLS, ID 83401
(208) 523-7571
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT00004503
WA
Other
Enumeration date
07/15/2007
Last updated
06/18/2018
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