Individual
LOGAN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5980 KYLE PKWY, KYLE, TX 78640-2400
(512) 308-3015
Mailing address
507 PRESSLER ST APT 4140, AUSTIN, TX 78703-5193
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
118693
TX
Other
Enumeration date
10/25/2017
Last updated
10/25/2017
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