Healthcare Provider Details

I. General information

NPI: 1508411752
Provider Name (Legal Business Name): LOGAN CATHERINE LAMALIE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/11/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 US-11 STATION #14
LIVINGSTON AL
35470
US

IV. Provider business mailing address

100 US-11 UWA STATION 14
LIVINGSTON AL
35470
US

V. Phone/Fax

Practice location:
  • Phone: 205-652-3714
  • Fax:
Mailing address:
  • Phone: 205-652-3714
  • Fax: 205-652-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2680
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: