Provider Demographics
NPI:1629898895
Name:SMITH, LOGAN ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 W HIGH ST APT 32B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-3153
Mailing Address - Country:US
Mailing Address - Phone:609-949-4066
Mailing Address - Fax:
Practice Address - Street 1:544 N PENRYN RD
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-8562
Practice Address - Country:US
Practice Address - Phone:609-949-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist