Basic Information
| Provider Information | |||||||||
| NPI: | 1811332919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | OTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3998 HIGHWAY 1 N | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723357637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706332120 | ||||||||
| FaxNumber: | 8706331738 | ||||||||
| Practice Location | |||||||||
| Address1: | 3998 HIGHWAY 1 N | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723357637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706332120 | ||||||||
| FaxNumber: | 8706331738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2013 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | O-T1304 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.