Provider Demographics
NPI:1396994711
Name:GAGNON, ERIN ANNE (ERIN GAGNON)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ANNE
Last Name:GAGNON
Suffix:
Gender:F
Credentials:ERIN GAGNON
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ANNE
Other - Last Name:GAGNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L, LAC MAOM
Mailing Address - Street 1:980 FOREST AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3336
Mailing Address - Country:US
Mailing Address - Phone:207-831-3703
Mailing Address - Fax:
Practice Address - Street 1:980 FOREST AVE STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3336
Practice Address - Country:US
Practice Address - Phone:207-831-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1068225X00000X
MEAC351171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist