Provider Demographics
NPI:1396039418
Name:BROGAN, MAGGIE ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ELIZABETH
Last Name:BROGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-7401
Mailing Address - Country:US
Mailing Address - Phone:781-775-1764
Mailing Address - Fax:
Practice Address - Street 1:545 MAIN ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3160
Practice Address - Country:US
Practice Address - Phone:508-548-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10254225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist