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General NPI Number Information
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NPI Number | 1952881930
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Entity Type | Individual
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Provider Name | JENNIFER BRUECKNER
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Gender | Female
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Dates
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Enumeration Date | 08/18/2018
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 49 YORKSHIRE DR
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City | QUEENSBURY
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State | NY
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Zip | 12804-8620
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Country | US
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Telephone | 562-858-5908
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Fax |
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Provider Business Mailing Address
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Address Line | 49 YORKSHIRE DR
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City | QUEENSBURY
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State | NY
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Zip | 12804-8620
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Country | US
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Telephone | 562-858-5908
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 14486
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 026254
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License Number State | NY
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