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General NPI Number Information
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NPI Number | 1639681406
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Entity Type | Individual
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Provider Name | BRADLEY BUCKELEW BCBA
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Gender | Male
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 455 SPRING DR
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City | OCALA
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State | FL
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Zip | 34472-8230
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Country | US
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Telephone | 386-589-8357
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Fax |
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Provider Business Mailing Address
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Address Line | 455 SPRING DR
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City | OCALA
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State | FL
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Zip | 34472-8230
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Country | US
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Telephone | 386-589-8357
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-01161
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA0316
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License Number State | MN
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