Provider Demographics
NPI:1740427483
Name:LOGAN, AMITRIA NECOLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMITRIA
Middle Name:NECOLE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:AMITRIA
Other - Middle Name:NECOLE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1053 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:159 SEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2315
Practice Address - Country:US
Practice Address - Phone:803-329-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist