Provider Demographics
NPI:1861602138
Name:O'CONNOR, MARIE JENNIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:JENNIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SOUTHWICK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2113
Mailing Address - Country:US
Mailing Address - Phone:978-664-0006
Mailing Address - Fax:
Practice Address - Street 1:200 BRICKSTONE SQ
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1437
Practice Address - Country:US
Practice Address - Phone:978-474-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA741224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant