Individual
MRS. RENEE L GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA L
Contact information
Practice address
30 WEBSTER ST, BROOKLINE, MA 02446-4938
(617) 734-2300
Mailing address
96 ELENE ST, LOWELL, MA 01854-1004
(978) 459-7666
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1741
MA
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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