Provider Demographics
NPI:1780993113
Name:GUIMOND GAGNON, PEGGY JO (OTR)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JO
Last Name:GUIMOND GAGNON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:JO
Other - Last Name:GUIMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-0814
Mailing Address - Country:US
Mailing Address - Phone:207-647-8777
Mailing Address - Fax:
Practice Address - Street 1:18 GROVE ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5610
Practice Address - Country:US
Practice Address - Phone:207-739-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1425225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist