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General NPI Number Information
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NPI Number | 1528512027
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Entity Type | Individual
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Provider Name | ELIZABETH LOGEL MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 400 N 6TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-1838
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Country | US
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Telephone | 636-443-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2031 BRAMBLETT XING
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City | O FALLON
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State | MO
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Zip | 63366-3262
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Country | US
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Telephone | 636-541-8922
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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 | 2016025475
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License Number State | MO
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