Provider Demographics
NPI:1437264769
Name:ALLEN, COLLEEN AILEEN (OT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:AILEEN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 CHICK CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-6220
Mailing Address - Country:US
Mailing Address - Phone:207-985-6590
Mailing Address - Fax:
Practice Address - Street 1:1 HAMPTON RD UNIT 200
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2995
Practice Address - Country:US
Practice Address - Phone:603-431-5600
Practice Address - Fax:603-431-5610
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0875225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
9984995OtherCIGNA GROUP #
NHRE8968OtherMEDICARE GROUP
NH1309918Y0NH02OtherANTHEM INDIV. # NH
611931000OtherDEPT OF LABOR FACILITY #
NH30414852Medicaid
ME098828OtherANTHEM INDIV. # MAINE
AA79032OtherHARVARD PILGRIM GROUP #
AA79032OtherHARVARD PILGRIM GROUP #