Provider Demographics
NPI:1396082723
Name:LESSARD, AMANDA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LESSARD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:NOWAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:25 HAFEY ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-3415
Mailing Address - Country:US
Mailing Address - Phone:413-537-0043
Mailing Address - Fax:
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1864
Practice Address - Country:US
Practice Address - Phone:413-304-2942
Practice Address - Fax:413-737-3000
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003999225X00000X
MA10707225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist