Individual
ALICIA LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1983 MARCUS AVE, NEW HYDE PARK, NY 11042-2000
(516) 326-5600
Mailing address
2700 REMSEN ST, BALDWIN, NY 11510-3829
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
016700-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01395326
—
NY
Enumeration date
07/06/2011
Last updated
11/23/2012
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