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General NPI Number Information
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NPI Number | 1558952168
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Entity Type | Individual
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Provider Name | LOGAN JAMES JOHNSTONE COTA/L
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Gender | Male
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 15291 NW 60TH AVE STE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2459
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Country | US
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Telephone | 305-705-7702
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Fax |
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Provider Business Mailing Address
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Address Line | 2850 NE 55TH PL
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3456
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Country | US
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Telephone | 859-699-0018
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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 | 17695
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License Number State | FL
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