Provider Demographics
NPI:1396051256
Name:LOGAN-BASKETT, RAQUEL MARIA (COTA)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:MARIA
Last Name:LOGAN-BASKETT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:RAQUEL
Other - Middle Name:MARIA
Other - Last Name:BASKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:20 WENDELL ST
Mailing Address - Street 2:APT. #6F
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1206
Mailing Address - Country:US
Mailing Address - Phone:516-385-1886
Mailing Address - Fax:
Practice Address - Street 1:415 BEVERLEY RD
Practice Address - Street 2:APT. UNIT LT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3153
Practice Address - Country:US
Practice Address - Phone:718-972-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004893-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant