Provider Demographics
NPI:1780704957
Name:BOUCHER, ANDRIA (OTRL)
Entity type:Individual
Prefix:
First Name:ANDRIA
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ANDRIA
Other - Middle Name:
Other - Last Name:CAMELIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2012
Mailing Address - Country:US
Mailing Address - Phone:781-504-6300
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8862225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist