Healthcare Provider Details

I. General information

NPI: 1134192040
Provider Name (Legal Business Name): DRAGONFLY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HAMMOND ST STE 2
BANGOR ME
04401-4339
US

IV. Provider business mailing address

840 HAMMOND ST STE 2
BANGOR ME
04401-4339
US

V. Phone/Fax

Practice location:
  • Phone: 207-433-7778
  • Fax: 207-433-7780
Mailing address:
  • Phone: 207-433-7778
  • Fax: 207-433-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANIELLE MARIE HAGGERTY
Title or Position: PRESIDENT
Credential:
Phone: 207-433-7778