Healthcare Provider Details

I. General information

NPI: 1578470951
Provider Name (Legal Business Name): KYLEE ALISE LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 ELIZABETH ST
SCOTT CITY KS
67871-1938
US

IV. Provider business mailing address

1313 ELIZABETH ST
SCOTT CITY KS
67871-1938
US

V. Phone/Fax

Practice location:
  • Phone: 620-214-1911
  • Fax:
Mailing address:
  • Phone: 620-214-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17-04643
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: