Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 8633 | MA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 8633 | MA |
NPI | 1063555910 |
---|---|
Provider Name | Marion L Gagnon |
First Address | Danvers, MA 01923-3225 |
Second Address | Danvers, MA 01923-3225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 16/03/2010 |