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General NPI Number Information
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NPI Number | 1396994711
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Entity Type | Individual
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Provider Name | ERIN ANNE GAGNON ERIN GAGNON
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Gender | Female
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 980 FOREST AVE STE 204
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City | PORTLAND
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State | ME
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Zip | 04103-3336
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Country | US
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Telephone | 207-831-3703
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Fax |
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Provider Business Mailing Address
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Address Line | 980 FOREST AVE STE 204
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City | PORTLAND
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State | ME
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Zip | 04103-3336
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Country | US
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Telephone | 207-831-3703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT1068
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC351
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License Number State | ME
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