Provider Demographics
NPI:1972233120
Name:REEVES, LOGAN ARTHUR (OTR/L)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:ARTHUR
Last Name:REEVES
Suffix:
Gender:M
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 1:7178 MANCHESTER RD APT 208
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-2458
Mailing Address - Country:US
Mailing Address - Phone:213-364-9194
Mailing Address - Fax:
Practice Address - Street 1:3115 S GRAND BLVD STE 224
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1047
Practice Address - Country:US
Practice Address - Phone:314-312-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022013051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist