Provider Demographics
NPI:1639486681
Name:O'CONNOR, AMY M (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WINTER ST STE 25
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-4958
Mailing Address - Country:US
Mailing Address - Phone:781-335-6663
Mailing Address - Fax:781-335-6686
Practice Address - Street 1:42 WINTER ST STE 25
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-4958
Practice Address - Country:US
Practice Address - Phone:781-335-6663
Practice Address - Fax:781-335-6686
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA616937OtherTUFTS