Healthcare Provider Details

I. General information

NPI: 1508172347
Provider Name (Legal Business Name): KEVIN PAUL BUCHANAN MS, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 ASPEN HILL RD
ROCKVILLE MD
20853-3709
US

IV. Provider business mailing address

52 WILDWAY
BRONXVILLE NY
10708-5918
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-3451
  • Fax: 13-933-0350
Mailing address:
  • Phone: 914-819-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number07513
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: