Provider Demographics
NPI:1184168767
Name:KAAKE, JESSICA ANN (OCCT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:KAAKE
Suffix:
Gender:F
Credentials:OCCT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:STOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OCCT
Mailing Address - Street 1:308 US ROUTE 1 STE E1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7640
Mailing Address - Country:US
Mailing Address - Phone:207-303-3030
Mailing Address - Fax:207-303-3033
Practice Address - Street 1:308 US ROUTE 1 STE E1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-303-3030
Practice Address - Fax:204-303-3033
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3152225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand