=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174926133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY BUKER OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2014
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13540 17TH ST
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33525-5244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-909-5578
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 232 DUQUE RD
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33549-5633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-909-5578
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OT25900
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT25900
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------