Provider Demographics
NPI:1285292128
Name:LONGCORE, EMERSON ROSE
Entity type:Individual
Prefix:
First Name:EMERSON
Middle Name:ROSE
Last Name:LONGCORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10129 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-9642
Mailing Address - Country:US
Mailing Address - Phone:231-720-5261
Mailing Address - Fax:
Practice Address - Street 1:10129 PINE ST
Practice Address - Street 2:
Practice Address - City:HOWARD CITY
Practice Address - State:MI
Practice Address - Zip Code:49329-9642
Practice Address - Country:US
Practice Address - Phone:231-720-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist