Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT3081 | ME |
NPI | 1083111488 |
---|---|
Provider Name | Mariah Arno Gagne |
First Address | Cape Elizabeth, ME 04107-2628 |
Second Address | Cape Elizabeth, ME 04107-2628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2018 |
Last Update Date | 12/07/2021 |