Individual
BETH MARIE JACKSON GAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
700 CENTRAL RD., RYE BEACH, NH 03871-0418
(603) 964-6508
Mailing address
PO BOX 418, RYE BEACH, NH 03871-0418
(603) 964-6508
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1792
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13Y008401NH01
BLUE CROSS BLUE SHIELD
NH
Enumeration date
11/24/2006
Last updated
07/08/2007
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