Provider Demographics
NPI:1750511309
Name:LEGRAMA, WALLEN JOY CLARETE (OT)
Entity Type:Individual
Prefix:MRS
First Name:WALLEN JOY
Middle Name:CLARETE
Last Name:LEGRAMA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:WALLEN JOY
Other - Middle Name:PASCUAL
Other - Last Name:CLARETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1013 RIVERBURCH PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8887
Mailing Address - Country:US
Mailing Address - Phone:866-261-8090
Mailing Address - Fax:706-226-7869
Practice Address - Street 1:350 CALLOWAY DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2974
Practice Address - Country:US
Practice Address - Phone:661-231-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004628225X00000X
CAOT10470225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist