Individual
BRANDON LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
5710 BAKER RD, MINNETONKA, MN 55345-5901
(612) 248-0236
Mailing address
5710 BAKER RD, MINNETONKA, MN 55345-5901
(612) 248-0236
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
104826
MN
Other
Enumeration date
02/09/2015
Last updated
02/09/2015
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