Organization
CIRQUE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA L GAGNON OTD, OTR/L (MEMBER, OCCUPATIONAL THERAPIST)
(907) 756-1101
Entity
Organization
Contact information
Practice address
653 W FAIRVIEW AVE, APT I, HOMER, AK 99603-7444
(907) 756-1101
Mailing address
PO BOX 2157, HOMER, AK 99603-2157
(907) 756-1101
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
2854
AK
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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