Organization
LEGACY HEALTHCARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE TRILL MS,OTR/L (OCCUPATIONAL THERAPIST)
(716) 807-5074
Entity
Organization
Contact information
Practice address
5114 PROVIDENCE RD, CHARLOTTE, NC 28226-5852
(704) 365-5252
Mailing address
4626 COLONY ROAD, APT I, CHARLOTTE, NC 28226-4980
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
7683
NC
Other
Enumeration date
01/06/2012
Last updated
01/06/2012
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