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General NPI Number Information
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NPI Number | 1629896741
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Entity Type | Individual
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Provider Name | LOGHAN NACE OT, MSOT, OTR
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Gender | Female
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Dates
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Enumeration Date | 09/27/2024
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 49 WALNUT ST
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City | WELLESLEY
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State | MA
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Zip | 02481-2117
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Country | US
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Telephone | 781-239-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 17 MORAINE ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-4315
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Country | US
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Telephone | 717-512-6490
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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 | 14451
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License Number State | MA
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