Active NPI
Logan Aric Tkach, OTR/L
- Occupational Therapist
- Livonia, MI
National Provider Identifier
1568197671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 462889
- Practice address
- 36475 Five Mile Rd
Livonia, MI 48154-1971 - Phone
- (313) 318-2403
- NPI assigned
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 462889 | MI | Primary |
Addresses
Primary practice location
36475 Five Mile Rd
Livonia, MI 48154-1971
Mailing address
9885 Manor Ave
Allen Park, MI 48101-1344
Phone (313) 318-2403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 462889 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1568197671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9885 MANOR AVE",
"city": "ALLEN PARK",
"state": "MI",
"postal_code": "481011344",
"telephone_number": "313-318-2403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36475 FIVE MILE RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481541971",
"telephone_number": "313-318-2403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TKACH",
"first_name": "LOGAN",
"middle_name": "ARIC",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-21",
"last_updated": "2022-07-21",
"certification_date": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "462889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.