Provider Demographics
NPI:1154529287
Name:LOGGINS, LEEANN STAFFORD (OT)
Entity type:Individual
Prefix:MS
First Name:LEEANN
Middle Name:STAFFORD
Last Name:LOGGINS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:LEEANN
Other - Middle Name:STAFFORD
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:105 LOGGINS TRAIL
Mailing Address - Street 2:
Mailing Address - City:POOLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76487
Mailing Address - Country:US
Mailing Address - Phone:817-694-5558
Mailing Address - Fax:
Practice Address - Street 1:1052 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-4558
Practice Address - Country:US
Practice Address - Phone:254-965-3611
Practice Address - Fax:254-965-3618
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102270225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist