Individual
MRS. SHANNON DAWN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
11080 E. GYPSY LANE RD., BOWLING GREEN, OH 43402
(419) 352-0259
Mailing address
191 LOSEE ST., PO BOX 274, CYGNET, OH 43413-0274
(419) 655-2970
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.02940
OH
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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