Provider Demographics
NPI:1437264769
Name:ALLEN, COLLEEN AILEEN (OT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:AILEEN
Last Name:ALLEN
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 GANNETT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6942
Mailing Address - Country:US
Mailing Address - Phone:207-773-0040
Mailing Address - Fax:207-661-4630
Practice Address - Street 1:119 GANNETT DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6942
Practice Address - Country:US
Practice Address - Phone:207-773-0040
Practice Address - Fax:207-661-4630
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0875225XH1200X
MEOT1302225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098828OtherANTHEM INDIV. # MAINE
9984995OtherCIGNA GROUP #
611931000OtherDEPT OF LABOR FACILITY #
AA79032OtherHARVARD PILGRIM GROUP #
NHRE8968OtherMEDICARE GROUP
NH1309918Y0NH02OtherANTHEM INDIV. # NH
NH30414852Medicaid
AA79032OtherHARVARD PILGRIM GROUP #