Provider Demographics
NPI:1033665930
Name:ZEITLER, LOGAN J (MS, OTR/L)
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:J
Last Name:ZEITLER
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-1332
Mailing Address - Country:US
Mailing Address - Phone:570-462-1921
Mailing Address - Fax:
Practice Address - Street 1:200 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1332
Practice Address - Country:US
Practice Address - Phone:570-462-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014541225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist