Provider Demographics
NPI:1114429792
Name:LEGRAND, STANLEY TROYD (OTR/L)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:TROYD
Last Name:LEGRAND
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HERRINGTON RD APT 19303
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-1817
Mailing Address - Country:US
Mailing Address - Phone:267-549-2966
Mailing Address - Fax:
Practice Address - Street 1:36 S CHARLES ST STE 203
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3121
Practice Address - Country:US
Practice Address - Phone:410-878-1014
Practice Address - Fax:404-393-5069
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004199225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist