Doctor Name: | MARY SUSAN LEGER |
NPI Number: | 1477806891 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MA 50906 |
Business Practice Address: | 119 Truxton Ave Fort Walton Beach, FL - 325472460 |
Business Phone Number: | 8508624313 |
Business Fax Number: | |
Mailing Address: | 107 Cristine Ct, NICEVILLE |
State: | FL |
Postal Code: | 325784713 |
Phone Number: | 8504960951 |
Fax Number: | |
NPI Enumeration Date: | 10/23/2012 |
NPI Last Update Date: | 10/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA 50906 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |