Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | VA | |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | VA |
NPI | 1861626715 |
---|---|
Provider Name | Linette Gagnon |
First Address | Woodbridge, VA 22193-2129 |
Second Address | Woodbridge, VA 22193-2129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 06/05/2009 |