Provider Demographics
NPI:1558829507
Name:LOGANBILL, JENA TAYLOR (OTD, OTR)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:TAYLOR
Last Name:LOGANBILL
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20911 W 153RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6219
Mailing Address - Country:US
Mailing Address - Phone:913-219-7309
Mailing Address - Fax:
Practice Address - Street 1:20911 W 153RD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-6219
Practice Address - Country:US
Practice Address - Phone:913-219-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-04030225X00000X
KSRBT-19-76794103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst