Individual
LOGAN DAVIDSON GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
211 MATHIS AVE, TWIN CITY, GA 30471-4232
(478) 763-2141
Mailing address
541 HULSEY DR, METTER, GA 30439-3609
(912) 243-1333
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA003034
GA
Other
Enumeration date
08/24/2024
Last updated
08/24/2024
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