Kimberly S Logue, OTRL

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT000986 Issued in GA

Practice address

3737 Roscommon N
Martinez, GA 30907-4741

Phone

(706) 860-9996

Fax

(706) 868-7497

NPI assigned

Dec 23, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Occupational Therapy, Inc.

  • Occupational Therapist
  • Martinez, GA
  • NPI 1215091186
  NPD (past)

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

{
    "created_epoch": "1166832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1487719159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1254 LOUISVILLE RD",
            "city": "HARLEM",
            "state": "GA",
            "postal_code": "308144215",
            "telephone_number": "706-860-9996",
            "fax_number": "706-868-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 ROSCOMMON N",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309074741",
            "telephone_number": "706-860-9996",
            "fax_number": "706-868-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGUE",
        "first_name": "KIMBERLY",
        "middle_name": "S",
        "credential": "OTRL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT000986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "339851",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Life Alarm Services, Inc
• Andreana Lindsay
• Michael John Lirette Jr.
• Jaquana Lobdell
• Jennifer Logan, DNP, PMHNP
• Ashley Sherwood London, PHARMD
• Grant Quan Loo, DMD
• Loving Hands Mobile Phlebotomy & More Services, LLC
• Alicia Lowe
• Kristen Luke, LMT

• Occupational Therapist in Martinez, GA
• Providers in Martinez, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.