Provider Demographics
NPI:1467838938
Name:KING, LOGAN (OTD, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LOGAN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 FEDERAL CIR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1165
Mailing Address - Country:US
Mailing Address - Phone:567-224-8352
Mailing Address - Fax:
Practice Address - Street 1:125 DILLMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4658
Practice Address - Country:US
Practice Address - Phone:614-547-8044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist