Provider Demographics
NPI:1417947946
Name:LISIECKI, DEBORAH JEAN (OT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:LISIECKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:203 TURNPIKE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5042
Mailing Address - Country:US
Mailing Address - Phone:978-975-1559
Mailing Address - Fax:978-975-7445
Practice Address - Street 1:203 TURNPIKE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5042
Practice Address - Country:US
Practice Address - Phone:978-975-1559
Practice Address - Fax:978-975-7445
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OT0063OtherBC/BS
MALIY69294Medicare ID - Type Unspecified