Provider Demographics
NPI:1720675366
Name:O'NEIL, LOGAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:O'NEIL
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 1:4776 E GUADALUPE RD APT 3042
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7594
Mailing Address - Country:US
Mailing Address - Phone:801-920-6093
Mailing Address - Fax:
Practice Address - Street 1:4776 E GUADALUPE RD APT 3042
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-7594
Practice Address - Country:US
Practice Address - Phone:801-920-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist