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General NPI Number Information
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NPI Number | 1912281569
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Entity Type | Individual
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Provider Name | DAWN BUCKOVINSKY IPPOLITO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 6 RAYMOND AVE
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City | MIDDLE ISLAND
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State | NY
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Zip | 11953-1427
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Country | US
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Telephone | 631-294-6316
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Fax | 631-775-0233
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Provider Business Mailing Address
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Address Line | 6 RAYMOND AVE
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City | MIDDLE ISLAND
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State | NY
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Zip | 11953-1427
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Country | US
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Telephone | 631-294-6316
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Fax | 631-775-0233
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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 | 225XE0001X
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Taxonomy Name | Environmental Modification Occupational Therapist
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License Number | 63014871
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License Number State | NY
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