Provider Demographics
NPI:1033981980
Name:E LEGARE, MAURICE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:E LEGARE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 LAWLOR TER
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-2148
Mailing Address - Country:US
Mailing Address - Phone:134-788-4463
Mailing Address - Fax:
Practice Address - Street 1:355 LAWLOR TER
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-2148
Practice Address - Country:US
Practice Address - Phone:134-788-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008411-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant