Provider Demographics
NPI:1508538240
Name:LOTT-INGLE, LOGAN RENEE (COTA)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:RENEE
Last Name:LOTT-INGLE
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 1:4355 S NATIONAL AVE APT 610
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2652
Mailing Address - Country:US
Mailing Address - Phone:417-521-8023
Mailing Address - Fax:
Practice Address - Street 1:129 ZINC RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5980
Practice Address - Country:US
Practice Address - Phone:479-234-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant