Provider Demographics
NPI:1780801555
Name:LOGHRY, RICHARD K (OTRL)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:LOGHRY
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 PLEASURE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-6364
Mailing Address - Country:US
Mailing Address - Phone:501-722-3105
Mailing Address - Fax:
Practice Address - Street 1:2307 PLEASURE DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019
Practice Address - Country:US
Practice Address - Phone:501-722-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y823OtherARBCBS
AR155067721Medicaid