Basic Information
| Provider Information | |||||||||
| NPI: | 1609898170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAGNON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | MARGO | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 NW 16TH ST | ||||||||
| Address2: | PM&RS 117 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331251624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055757000 | ||||||||
| FaxNumber: | 3055753415 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 NW 16TH ST | ||||||||
| Address2: | PM&RS 117 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331251624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055757000 | ||||||||
| FaxNumber: | 3055753415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 09/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT9778 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.