Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC011032 | PA |
NPI | 1386004596 |
---|---|
Provider Name | Nicole Buckman |
First Address | Perkiomenville, PA 18074-9342 |
Second Address | Perkiomenville, PA 18074-9342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2016 |
Last Update Date | 01/03/2016 |