Healthcare Provider Details

I. General information

NPI: 1508728965
Provider Name (Legal Business Name): LYDIA JANE REPPUCCI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 GOULD ST
NEEDHAM MA
02494-2354
US

IV. Provider business mailing address

235 GOULD ST
NEEDHAM MA
02494-2354
US

V. Phone/Fax

Practice location:
  • Phone: 781-734-7930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15458
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: