Individual
KIMBERLY S LOGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
3737 ROSCOMMON N, MARTINEZ, GA 30907-4741
(706) 860-9996
(706) 868-7497
Mailing address
1254 LOUISVILLE RD, HARLEM, GA 30814-4215
(706) 860-9996
(706) 868-7497
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT000986
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
339851
WELLCARE
GA
Enumeration date
12/23/2006
Last updated
07/09/2007
About Stedi
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