Basic Information
| Provider Information | |||||||||
| NPI: | 1215650932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONEYCUTT | ||||||||
| FirstName: | LOGAN | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 W WILL ROGERS BLVD | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740175421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3414343341 | ||||||||
| FaxNumber: | 9183418687 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 W WILL ROGERS BLVD | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740175421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3414343341 | ||||||||
| FaxNumber: | 9183418687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2022 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5702 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.