Individual
MRS. DIANA L LONGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3631 S 6TH ST, SPRINGFIELD, IL 62703-4777
(217) 529-0988
Mailing address
3631 S 6TH ST, SPRINGFIELD, IL 62703-4777
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
005350
OH
225X00000X
Occupational Therapist
Primary
056.009018
IL
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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