Provider Demographics
NPI:1275012759
Name:LEGO, KATRINA (MS)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LEGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 PAINTERS WOODS RD
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-6331
Mailing Address - Country:US
Mailing Address - Phone:716-450-9101
Mailing Address - Fax:
Practice Address - Street 1:1 COURT SQ
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-3701
Practice Address - Country:US
Practice Address - Phone:540-434-9916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-007817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist