Logan James Wilberding, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

7115-27 Issued in WI

Practice address

470 Garfield Ave
Evansville, WI 53536-1099

Phone

(608) 882-6559

NPI assigned

Nov 28, 2023

Last updated

Nov 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1104692458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 E WASHINGTON AVE APT 410",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537034413",
            "telephone_number": "954-778-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 GARFIELD AVE",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361099",
            "telephone_number": "608-882-6559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBERDING",
        "first_name": "LOGAN",
        "middle_name": "JAMES",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-28",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "7115-27",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Evansville, WI
• Providers in Evansville, WI by specialty
• Occupational Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.