Active NPI
Logan A Gabrielsen, OTR/L
- Occupational Therapist
- Fort Mill, SC
National Provider Identifier
1700442506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5913
- Practice address
- 522 6TH Baxter Xing Ste B
Fort Mill, SC 29708-6613 - Phone
- (803) 929-7408
- Fax
- (888) 711-0441
- NPI assigned
- May 16, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 4399 | MA | |
| Occupational Therapist | 225X00000X | 5913 | SC | Primary |
Addresses
Primary practice location
522 6TH Baxter Xing Ste B
Fort Mill, SC 29708-6613
Mailing address
10 S 9TH St
Ste 4
Noblesville, IN 46060-2631
Phone (765) 524-3946
Other practice location 1
3 Lyman St
Westborough, MA 01581-1442
Phone (508) 366-9933
Other practice location 2
2701 Chestnut Station Ct
Louisville, KY 40299-6395
Phone (800) 335-1060
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606176000000",
"number": "1700442506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 S 9TH ST",
"address_2": "STE 4",
"city": "NOBLESVILLE",
"state": "IN",
"postal_code": "460602631",
"telephone_number": "765-524-3946",
"fax_number": "317-708-6496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "522 6TH BAXTER XING STE B",
"city": "FORT MILL",
"state": "SC",
"postal_code": "297086613",
"telephone_number": "803-929-7408",
"fax_number": "888-711-0441"
}
],
"practiceLocations": [
{
"address_1": "3 Lyman St",
"address_purpose": "LOCATION",
"city": "Westborough",
"state": "MA",
"postal_code": "015811442",
"country_code": "US",
"telephone_number": "508-366-9933",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2701 Chestnut Station Ct",
"address_purpose": "LOCATION",
"city": "Louisville",
"state": "KY",
"postal_code": "402996395",
"country_code": "US",
"telephone_number": "800-335-1060",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GABRIELSEN",
"first_name": "LOGAN",
"middle_name": "A",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-16",
"last_updated": "2020-11-24",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MA",
"license": "4399",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "5913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Mill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.