Provider Demographics
NPI:1134192040
Name:DRAGONFLY THERAPY
Entity type:Organization
Organization Name:DRAGONFLY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-433-7778
Mailing Address - Street 1:840 HAMMOND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4339
Mailing Address - Country:US
Mailing Address - Phone:207-433-7778
Mailing Address - Fax:207-433-7780
Practice Address - Street 1:840 HAMMOND ST STE 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4339
Practice Address - Country:US
Practice Address - Phone:207-433-7778
Practice Address - Fax:207-433-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1668152OtherAETNA
MEAA65965OtherHARVARD PILGRIM
ME434571000Medicaid
ME040462OtherBLUE CROSS & BLUE SHIELD
MEDE4681OtherRAILROAD MEDICARE
MEME1770Medicare PIN