Individual
DANIELLE COLSTON LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4900 IVEY RD NW STE 1720, ACWORTH, GA 30101-4101
(770) 917-5737
Mailing address
659 HOLLY ST, CANTON, GA 30114-9595
(770) 617-2598
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT007594
GA
Other
Enumeration date
11/30/2019
Last updated
11/30/2019
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