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General NPI Number Information
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NPI Number | 1346776192
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Entity Type | Individual
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Provider Name | KELLY K. BUCK
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 221 RACE ST APT 5
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City | BAINBRIDGE
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State | PA
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Zip | 17502-9013
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Country | US
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Telephone | 717-736-0656
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Fax |
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Provider Business Mailing Address
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Address Line | 737 MARIETTA AVE APT 1
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City | LANCASTER
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State | PA
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Zip | 17603-3437
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Country | US
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Telephone | 717-736-0656
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 010616
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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