Provider Demographics
NPI:1639783640
Name:LAGANELLA, GINA (OTR)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LAGANELLA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 DORCHESTER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-4493
Mailing Address - Country:US
Mailing Address - Phone:973-960-5410
Mailing Address - Fax:
Practice Address - Street 1:11 MCGRATH HWY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5311
Practice Address - Country:US
Practice Address - Phone:617-479-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist