Provider Demographics
NPI:1669034831
Name:GOUGEON, MADELINE MAYA (LICENSED ORTHOTIST)
Entity Type:Individual
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First Name:MADELINE
Middle Name:MAYA
Last Name:GOUGEON
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Gender:F
Credentials:LICENSED ORTHOTIST
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Mailing Address - Street 1:HOPE ORTHOTICS, LLC - ATTN: MAYA GOUGEON, LO
Mailing Address - Street 2:230 SPRING HILL DRIVE, SUITE 335
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2388
Mailing Address - Country:US
Mailing Address - Phone:877-297-8999
Mailing Address - Fax:877-206-0482
Practice Address - Street 1:HOPE ORTHOTICS, LLC - ATTN: MAYA GOUGEON, LO
Practice Address - Street 2:230 SPRING HILL DRIVE, SUITE 335
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2388
Practice Address - Country:US
Practice Address - Phone:877-297-8999
Practice Address - Fax:877-206-0482
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
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Provider Licenses
StateLicense IDTaxonomies
TX1995222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1995OtherLICENSED ORTHOTIST