Individual
MADISON LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7701 E 21ST ST, INDIANAPOLIS, IN 46219-2406
(317) 513-1986
Mailing address
7701 E 21ST ST, INDIANAPOLIS, IN 46219-2406
(317) 513-1986
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31007468A
IN
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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