# LEGENDARY THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861837288
- **Authorized official:** CHRISTINE SALOMON MA, OTR/L (CLINICAL SUPERVISOR)
- **Authorized official phone:** (917) 853-1226

## Contact information

- **Practice address:** 997 STAFFORD AVE, STATEN ISLAND, NY 10309-2109
- **Practice address phone:** (917) 853-1226
- **Practice address fax:** (718) 679-9823
- **Mailing address:** 997 STAFFORD AVE, STATEN ISLAND, NY 10309-2109
- **Mailing address phone:** (917) 853-1226
- **Mailing address fax:** (718) 679-9823

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/30/2013
- **Last updated:** 04/30/2013