NPIMap

Organization Active NPI

Legacy Healthcare Services

  • Occupational Therapist
  • Charlotte, NC
National Provider Identifier
1043580129
Registry record updated Jan 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
7683 Issued in NC
Legal business name
LEGACY HEALTHCARE SERVICES
Practice address
5114 Providence Rd
Charlotte, NC 28226-5852
Phone
(704) 365-5252
NPI assigned
Jan 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacqueline Trill, MS,OTR/L
Title
Occupational Therapist
Phone
(716) 807-5074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X 7683 NC Primary

Addresses

Primary practice location

5114 Providence Rd
Charlotte, NC 28226-5852

Mailing address

4626 Colony Road
Apt I
Charlotte, NC 28226-4980

National Provider Directory

National Provider Directory
Tax ID family
Legacy61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325808000000",
    "number": "1043580129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 COLONY ROAD",
            "address_2": "APT I",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282264980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5114 PROVIDENCE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282265852",
            "telephone_number": "704-365-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-06",
        "last_updated": "2012-01-06",
        "status": "A",
        "authorized_official_last_name": "TRILL",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "716-807-5074",
        "authorized_official_credential": "MS,OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "7683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.