Provider Demographics
NPI:1104332949
Name:LEGGETT, AMOS LAMAR
Entity type:Individual
Prefix:
First Name:AMOS
Middle Name:LAMAR
Last Name:LEGGETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7948 EMBASSY BLVD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6412
Mailing Address - Country:US
Mailing Address - Phone:786-444-0386
Mailing Address - Fax:
Practice Address - Street 1:5821 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5152
Practice Address - Country:US
Practice Address - Phone:954-987-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician