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General NPI Number Information
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NPI Number | 1467578328
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Entity Type | Individual
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Provider Name | MARY JANE BUCK OTR
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | E. MAIN STREET
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City | SHELBY
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State | OH
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Zip | 44875
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Country | US
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Telephone | 419-347-1503
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Fax |
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Provider Business Mailing Address
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Address Line | 745 CHERRY ST
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City | GALION
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State | OH
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Zip | 44833-2407
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Country | US
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Telephone | 419-777-2507
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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 | OT0004235
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License Number State | OH
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