Provider Demographics
NPI:1861626715
Name:GAGNON, LINETTE (OT)
Entity Type:Individual
Prefix:
First Name:LINETTE
Middle Name:
Last Name:GAGNON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LINETTE
Other - Middle Name:CULVER
Other - Last Name:GAGNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:14420 HEREFORD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2129
Mailing Address - Country:US
Mailing Address - Phone:703-670-8904
Mailing Address - Fax:
Practice Address - Street 1:14420 HEREFORD RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2129
Practice Address - Country:US
Practice Address - Phone:703-670-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225XG0600X, 225XP0200X
225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics