Provider Demographics
NPI:1558065755
Name:CHRISTENSEN, LOGAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14249 SKIPPING STONE LOOP
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-1436
Mailing Address - Country:US
Mailing Address - Phone:571-251-7183
Mailing Address - Fax:
Practice Address - Street 1:7375 STONE RIVER RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-8057
Practice Address - Country:US
Practice Address - Phone:941-229-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist