Provider Demographics
NPI:1932605060
Name:GAGNER, TANIA NICOLE (MT-BC)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:NICOLE
Last Name:GAGNER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MRS
Other - First Name:TANIA
Other - Middle Name:N
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2049
Mailing Address - Country:US
Mailing Address - Phone:443-504-5850
Mailing Address - Fax:
Practice Address - Street 1:24 VILLAGE PL
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2049
Practice Address - Country:US
Practice Address - Phone:443-504-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13574225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty