Provider Demographics
NPI:1003645458
Name:LONGACRE, AMANDA (OTD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LONGACRE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BLAKE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2002
Mailing Address - Country:US
Mailing Address - Phone:540-339-1097
Mailing Address - Fax:
Practice Address - Street 1:311 SPOTSWOOD ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-8627
Practice Address - Country:US
Practice Address - Phone:732-251-5200
Practice Address - Fax:732-251-5227
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01195300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist