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General NPI Number Information
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NPI Number | 1407261795
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Entity Type | Individual
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Provider Name | KELLEY LEGGE ATC,LAT,OTC,OPE-C
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Gender | Female
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 111 MICHIGAN AVE NW WEST WING ORTHOPAEDICS 1.5
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City | WASHINGTON
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State | DC
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Zip | 20010
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Country | US
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Telephone | 202-476-7091
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Fax |
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Provider Business Mailing Address
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Address Line | 111 MICHIGAN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20010-2916
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126001547
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 246ZX2200X
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Taxonomy Name | Orthopedic Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A00059
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License Number State | MD
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