Healthcare Provider Details

I. General information

NPI: 1831919968
Provider Name (Legal Business Name): JENNIFER ALEXOPOULOS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HEBRON AVE STE 205
GLASTONBURY CT
06033-2421
US

IV. Provider business mailing address

622 HEBRON AVE STE 205
GLASTONBURY CT
06033-2421
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-7161
  • Fax: 860-652-8411
Mailing address:
  • Phone: 860-527-7161
  • Fax: 860-652-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5427
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: