Provider Demographics
NPI:1063755577
Name:GAGNON, MEEGAN LANE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MEEGAN
Middle Name:LANE
Last Name:GAGNON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CHELTENHAM DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1840
Mailing Address - Country:US
Mailing Address - Phone:603-396-6455
Mailing Address - Fax:
Practice Address - Street 1:57 CHELTENHAM DR
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1840
Practice Address - Country:US
Practice Address - Phone:603-396-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012734225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist