MEDICARE: MRS. CRISTIN ANNE GASSON OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	31003821A	IN
2	225X00000X	Occupational Therapist	0119005233	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508919598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRISTIN ANNE GASSON OTR

Provider Business Mailing Address
First Line	:	906 TRAILVIEW BLVD SE
Second Line	:	SUITE A
City	:	LEESBURG
State	:	VA
Zip	:	20175-4415
Country	:	US
Telephone Number	:	517-920-1490
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 TRAILVIEW BLVD SE
Second Line	:	SUITE A
City	:	LEESBURG
State	:	VA
Zip	:	20175-4415
Country	:	US
Telephone Number	:	517-920-1490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	12/14/2010

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