Provider Demographics
NPI:1356516066
Name:LONG, ANNE IRVINE (OTR)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:IRVINE
Last Name:LONG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:IRVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4901 DEERFOOT PKWY
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2697
Mailing Address - Country:US
Mailing Address - Phone:205-661-0810
Mailing Address - Fax:205-661-9841
Practice Address - Street 1:2801 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1859
Practice Address - Country:US
Practice Address - Phone:205-744-7311
Practice Address - Fax:205-744-7814
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0722225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist