Individual
MOLLY GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4560 SE INTERNATIONAL WAY STE 100, PORTLAND, OR 97222-4628
(503) 706-2442
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2524
CA
Other
Enumeration date
02/05/2016
Last updated
02/05/2016
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