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General NPI Number Information
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NPI Number | 1639770159
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Entity Type | Individual
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Provider Name | LOGAN LONG COTA
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Gender | Male
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 275 SW 160TH ST STE 105
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City | BURIEN
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State | WA
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Zip | 98166-3073
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Country | US
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Telephone | 206-513-2155
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Fax | 206-513-2886
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Provider Business Mailing Address
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Address Line | 275 SW 160TH ST STE 105
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City | BURIEN
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State | WA
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Zip | 98166-3073
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Country | US
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Telephone | 206-513-2155
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Fax | 206-513-2886
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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 | OT70029666
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License Number State | WA
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