Healthcare Provider Details

I. General information

NPI: 1881491124
Provider Name (Legal Business Name): KRISTEN CUCCOLI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BRIDGE ST
NEWTON MA
02458-1147
US

IV. Provider business mailing address

90 PARKER ST
WESTWOOD MA
02090-1215
US

V. Phone/Fax

Practice location:
  • Phone: 617-969-4410
  • Fax:
Mailing address:
  • Phone: 781-375-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTL14346
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: