Provider Demographics
NPI:1588957773
Name:LEGERE, JULIE ANN (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:LEGERE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 FARM TO MARKET RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-9050
Mailing Address - Country:US
Mailing Address - Phone:518-279-4188
Mailing Address - Fax:
Practice Address - Street 1:623 LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4031
Practice Address - Country:US
Practice Address - Phone:518-782-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016756-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04889718Medicaid