Provider Demographics
NPI:1659986727
Name:LOGAN, CARRON A (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARRON
Middle Name:A
Last Name:LOGAN
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 1:945 ARNOW AVE # 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3905
Mailing Address - Country:US
Mailing Address - Phone:646-708-2877
Mailing Address - Fax:
Practice Address - Street 1:945 ARNOW AVE # 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3905
Practice Address - Country:US
Practice Address - Phone:646-708-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist