Healthcare Provider Details

I. General information

NPI: 1174926133
Provider Name (Legal Business Name): EMILY BUKER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13540 17TH ST
DADE CITY FL
33525-5244
US

IV. Provider business mailing address

232 DUQUE RD
LUTZ FL
33549-5633
US

V. Phone/Fax

Practice location:
  • Phone: 813-909-5578
  • Fax:
Mailing address:
  • Phone: 813-909-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT25900
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT25900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: