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Individual

MS. TRACY ANN LOGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
25 AUTUMNWOOD TRL, ORMOND BEACH, FL 32174-4335
(386) 290-6310
Mailing address
25 AUTUMNWOOD TRL, ORMOND BEACH, FL 32174-4335
(386) 290-6310

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
001017
IA
224Z00000X
Occupational Therapy Assistant
Primary
13006
FL
224Z00000X
Occupational Therapy Assistant
212209
TX
224Z00000X
Occupational Therapy Assistant
2672
CA

Other

Enumeration date
02/11/2014
Last updated
02/11/2014
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