Healthcare Provider Details

I. General information

NPI: 1295812907
Provider Name (Legal Business Name): LEA ANN BUFFENBARGER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 ARDLUSSA ST
UMATILLA FL
32784-7604
US

IV. Provider business mailing address

61 ARDLUSSA ST
UMATILLA FL
32784-7604
US

V. Phone/Fax

Practice location:
  • Phone: 352-636-8188
  • Fax:
Mailing address:
  • Phone: 352-636-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT7683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: