Healthcare Provider Details

I. General information

NPI: 1689524449
Provider Name (Legal Business Name): BROOKE NICOLE OTT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 IMPERIAL DR STE 300
HAGERSTOWN MD
21740-6556
US

IV. Provider business mailing address

110 SUNHIGH DR
THURMONT MD
21788-3214
US

V. Phone/Fax

Practice location:
  • Phone: 301-665-9098
  • Fax:
Mailing address:
  • Phone: 240-818-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: