Individual
ANDREA MICHELE LOGWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
111 FAYETTE AVENUE, FAYETTEVILLE, WV 25840
(304) 222-1421
Mailing address
PO BOX 299, BECKLEY, WV 25802
(304) 222-1421
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1361
WV
225XP0200X
Pediatric Occupational Therapist
Primary
1361
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810011514
—
WV
Enumeration date
07/08/2008
Last updated
07/08/2008
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