Healthcare Provider Details

I. General information

NPI: 1538024450
Provider Name (Legal Business Name): AMANDA MARY BASTOS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 PARK AVE
ARLINGTON MA
02476-5829
US

IV. Provider business mailing address

34 CHRISTINA AVE
BILLERICA MA
01821-5522
US

V. Phone/Fax

Practice location:
  • Phone: 781-648-9530
  • Fax:
Mailing address:
  • Phone: 339-234-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL36379
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: