Healthcare Provider Details

I. General information

NPI: 1710723440
Provider Name (Legal Business Name): BROOKE G ALLISON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KACY BROOKE GREGORY OTR/L

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

515 MITCHELL RD
CAPE ELIZABETH ME
04107-1623
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT4534
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: