Provider Demographics
NPI:1871934737
Name:LONG, LINDA D (MS OTR/L)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:LONG
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2913
Mailing Address - Country:US
Mailing Address - Phone:701-214-1395
Mailing Address - Fax:
Practice Address - Street 1:1313 N 20TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2913
Practice Address - Country:US
Practice Address - Phone:701-214-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist