Provider Demographics
NPI:1588877351
Name:LEGG, VICKI JEAN (MS, ATC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:JEAN
Last Name:LEGG
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:117 RODNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT NEBO
Mailing Address - State:WV
Mailing Address - Zip Code:26679-8206
Mailing Address - Country:US
Mailing Address - Phone:304-382-7973
Mailing Address - Fax:
Practice Address - Street 1:405 FAYETTE PIKE
Practice Address - Street 2:WVU TECH ATHLETIC TRAINING
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2437
Practice Address - Country:US
Practice Address - Phone:304-442-3496
Practice Address - Fax:304-442-3499
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer