Provider Demographics
NPI:1720177736
Name:GAGNON, ABIGAIL LYNN (AT, ATC, CFO)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:LYNN
Last Name:GAGNON
Suffix:
Gender:F
Credentials:AT, ATC, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3529
Mailing Address - Country:US
Mailing Address - Phone:616-638-6621
Mailing Address - Fax:
Practice Address - Street 1:1363 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3529
Practice Address - Country:US
Practice Address - Phone:616-638-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer