Provider Demographics
NPI:1689874224
Name:BOUCAKIS, CHERYL ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:BOUCAKIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 HAYDENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9767
Mailing Address - Country:US
Mailing Address - Phone:413-586-7700
Mailing Address - Fax:
Practice Address - Street 1:349 HAYDENVILLE RD
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9767
Practice Address - Country:US
Practice Address - Phone:413-586-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9431225X00000X
CT003859225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist