Healthcare Provider Details

I. General information

NPI: 1386551877
Provider Name (Legal Business Name): LOGAN SCHWAB LRT, CTRS, CBIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BRAZIER LN
KENNEBUNK ME
04043-6938
US

IV. Provider business mailing address

3 BRAZIER LN
KENNEBUNK ME
04043-6938
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-3030
  • Fax:
Mailing address:
  • Phone: 207-985-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number4742
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: