Provider Demographics
NPI:1265673354
Name:LONG-DALY, JENNIFER R (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:LONG-DALY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MANZANO ST NE APT 5
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1380
Mailing Address - Country:US
Mailing Address - Phone:505-620-9904
Mailing Address - Fax:
Practice Address - Street 1:201 MANZANO ST NE APT 5
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1380
Practice Address - Country:US
Practice Address - Phone:505-620-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist