Healthcare Provider Details

I. General information

NPI: 1184277477
Provider Name (Legal Business Name): BETH BRUCKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 DUBLIN RD STE 200B
COLUMBUS OH
43215-7094
US

IV. Provider business mailing address

7634 STARMONT CT
DUBLIN OH
43016-9565
US

V. Phone/Fax

Practice location:
  • Phone: 614-595-9037
  • Fax:
Mailing address:
  • Phone: 317-797-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: