Provider Demographics
NPI:1083395610
Name:LEGG, CASSIE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:LEGG
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 N CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-3622
Mailing Address - Country:US
Mailing Address - Phone:918-231-2076
Mailing Address - Fax:
Practice Address - Street 1:5550 W COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3672
Practice Address - Country:US
Practice Address - Phone:918-231-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist