Healthcare Provider Details

I. General information

NPI: 1629677273
Provider Name (Legal Business Name): ANDREA MARY LIACOPOULOS OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 NEWBURY ST FL 5
BOSTON MA
02115-2727
US

IV. Provider business mailing address

131 RATTLESNAKE HILL RD
ANDOVER MA
01810-6012
US

V. Phone/Fax

Practice location:
  • Phone: 617-302-6244
  • Fax:
Mailing address:
  • Phone: 781-985-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13775
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: