Provider Demographics
NPI:1871875229
Name:LEGG, LEANNE (OT)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:LEGG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CONKEY AVE
Mailing Address - Street 2:BOX 136
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1756
Mailing Address - Country:US
Mailing Address - Phone:607-334-5010
Mailing Address - Fax:607-336-7326
Practice Address - Street 1:42084 ROUTE 28
Practice Address - Street 2:BOX 200
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455-0200
Practice Address - Country:US
Practice Address - Phone:607-334-5010
Practice Address - Fax:607-336-7326
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist