Provider Demographics
NPI:1043790694
Name:LOGAN, APRIL DAWN (COTA)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:DAWN
Last Name:LOGAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W GOODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6502
Mailing Address - Country:US
Mailing Address - Phone:361-576-0694
Mailing Address - Fax:
Practice Address - Street 1:104 REX KERWIN CT
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2630
Practice Address - Country:US
Practice Address - Phone:512-251-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208760224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant