Provider Demographics
NPI:1548460140
Name:LONG-SLADE, ANNA KATHLEEN (OTR/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHLEEN
Last Name:LONG-SLADE
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 1:32349 CERCLE LATOUR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4956
Mailing Address - Country:US
Mailing Address - Phone:858-286-8621
Mailing Address - Fax:
Practice Address - Street 1:32349 CERCLE LATOUR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4956
Practice Address - Country:US
Practice Address - Phone:858-286-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist