Active NPI
Brandon Long, OT
- Pediatric Occupational Therapist
- Minnetonka, MN
National Provider Identifier
1891186110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 104826
- Practice address
- 5710 Baker Rd
Minnetonka, MN 55345-5901 - Phone
- (612) 248-0236
- NPI assigned
- Feb 9, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 104826 | MN | Primary |
Addresses
Primary practice location
5710 Baker Rd
Minnetonka, MN 55345-5901
Mailing address
5710 Baker Rd
Minnetonka, MN 55345-5901
Phone (612) 248-0236
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104826 | MN | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423440000000",
"number": "1891186110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5710 BAKER RD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553455901",
"telephone_number": "612-248-0236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5710 BAKER RD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553455901",
"telephone_number": "612-248-0236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "BRANDON",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-09",
"last_updated": "2015-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "MN",
"license": "104826",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.