Individual
MARIA GAGNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
8655 RIVER ROCK CT, BALL GROUND, GA 30107-3592
(770) 597-9737
Mailing address
8655 RIVER ROCK CT, BALL GROUND, GA 30107-3592
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004087
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT004087
STATE LICENSE
GA
Enumeration date
04/09/2014
Last updated
04/09/2014
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