Provider Demographics
NPI:1588079677
Name:LEGACY THERAPY SERVICES LLC
Entity type:Organization
Organization Name:LEGACY THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BOGGESS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CTRS, OTR/L
Authorized Official - Phone:304-743-5267
Mailing Address - Street 1:2216 NEWMANS BRANCH ROAD
Mailing Address - Street 2:RURAL ROUTE 3 BOX 297
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541
Mailing Address - Country:US
Mailing Address - Phone:304-743-5267
Mailing Address - Fax:304-743-5267
Practice Address - Street 1:2216 NEWMANS BRANCH ROAD
Practice Address - Street 2:RURAL ROUTE 3 BOX 397
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541
Practice Address - Country:US
Practice Address - Phone:304-634-1845
Practice Address - Fax:304-743-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2261-3593225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty