Healthcare Provider Details

I. General information

NPI: 1003732918
Provider Name (Legal Business Name): LOGAN KUSKIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 MELODY DR STE 100
NORTHGLENN CO
80234-4123
US

IV. Provider business mailing address

2221 BILLINGS LN
LONGMONT CO
80504-2306
US

V. Phone/Fax

Practice location:
  • Phone: 720-872-6472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: