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General NPI Number Information
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NPI Number | 1225834823
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Entity Type | Individual
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Provider Name | REBECCA BUCKINGHAM
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1020 HILL ST
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City | WATERTOWN
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State | WI
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Zip | 53098-3016
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Country | US
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Telephone | 844-206-4930
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 11TH ST S
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City | LA CROSSE
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State | WI
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Zip | 54601-5515
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Country | US
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Telephone | 715-308-7006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 8828-26
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License Number State | WI
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