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General NPI Number Information
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NPI Number | 1386310415
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Entity Type | Individual
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Provider Name | LOGAN WAYNE STEM OTR/L
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Gender | Male
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 504 ELMINGTON AVE
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City | NASHVILLE
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State | TN
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Zip | 37205-2508
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Country | US
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Telephone | 615-292-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 LIBERTY LN
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City | GALLATIN
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State | TN
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Zip | 37066-9146
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Country | US
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Telephone | 615-973-5072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6975
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License Number State | TN
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