Healthcare Provider Details

I. General information

NPI: 1619680337
Provider Name (Legal Business Name): LOGEN JOANNE AMUNDSEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W WARD ST
ASHEBORO NC
27203-5426
US

IV. Provider business mailing address

PO BOX 749
BELMONT NC
28012-0749
US

V. Phone/Fax

Practice location:
  • Phone: 743-224-7464
  • Fax: 336-628-7007
Mailing address:
  • Phone: 704-869-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1991
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17071
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: