Individual provider Active NPI

Pamela Long, OT

  • Physical Rehabilitation Occupational Therapist
  • Glen Carbon, IL
National Provider Identifier
1700025475
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X
Practice address
12 Saffrin Hill CT
Glen Carbon, IL 62034-1561
Phone
(314) 877-8754
NPI assigned
Feb 19, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X
Neurorehabilitation Occupational Therapist 225XN1300X
Physical Rehabilitation Occupational Therapist 225XP0019X Primary
Pediatric Occupational Therapist 225XP0200X 113413 TX

Addresses

Primary practice location

12 Saffrin Hill CT
Glen Carbon, IL 62034-1561

Mailing address

PO Box 203
Maryville, IL 62062-0203
Phone (314) 877-8754

Other practice location 1

1380 River Bend Dr
Dallas, TX 75247-4914
Phone (214) 743-6159

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
113413TXMDPediatric Occupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1700025475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 203",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620620203",
            "telephone_number": "314-877-8754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SAFFRIN HILL CT",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341561",
            "telephone_number": "314-877-8754"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1380 River Bend Dr",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752474914",
            "country_code": "US",
            "telephone_number": "214-743-6159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "PAMELA",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-19",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "113413",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Carbon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.