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General NPI Number Information
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NPI Number | 1508538240
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Entity Type | Individual
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Provider Name | LOGAN RENEE LOTT-INGLE COTA
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Gender | Female
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 129 ZINC RD
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City | HARRISON
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State | AR
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Zip | 72601-5980
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Country | US
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Telephone | 479-234-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 4355 S NATIONAL AVE APT 610
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City | SPRINGFIELD
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State | MO
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Zip | 65810-2652
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Country | US
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Telephone | 417-521-8023
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State | AR
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