Provider Demographics
NPI:1720091275
Name:XINTAROPOULOS, AUDREY ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ANN
Last Name:XINTAROPOULOS
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 1:46 MAYNARD ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4606
Mailing Address - Country:US
Mailing Address - Phone:781-605-0575
Mailing Address - Fax:
Practice Address - Street 1:46 MAYNARD ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4606
Practice Address - Country:US
Practice Address - Phone:781-605-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704491Medicaid
MAXI-Y69632Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST