Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT2090 | ME |
NPI | 1639625379 |
---|---|
Provider Name | Kelsi Gagne |
First Address | Portland, ME 04103 |
Second Address | Westbrook, ME 04092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |