MEDICARE: MRS. TRICIA BUCKLER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	OC006477L	PA
2	225X00000X	Occupational Therapist	OC006477L	PA

General Provider Information

NPI Number	:	1902093875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRICIA BUCKLER OTR/L

Provider Business Mailing Address
First Line	:	2039 ADAMS RD
Second Line	:
City	:	EAST GREENVILLE
State	:	PA
Zip	:	18041-2330
Country	:	US
Telephone Number	:	215-527-8762
Fax Number	:

Provider Business Practice Location Address
First Line	:	2039 ADAMS RD
Second Line	:
City	:	EAST GREENVILLE
State	:	PA
Zip	:	18041-2330
Country	:	US
Telephone Number	:	215-527-8762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/10/2012

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