Basic Information
| Provider Information | |||||||||
| NPI: | 1124576525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | LOGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1143 HIGHWAY 162 | ||||||||
| Address2: | |||||||||
| City: | CEDARVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793532679 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 CHARLEVOIX DR SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495467085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169755092 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OT-A1126 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.