Provider Demographics
NPI:1902093875
Name:BUCKLER, TRICIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:
Last Name:BUCKLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18041-2330
Mailing Address - Country:US
Mailing Address - Phone:215-527-8762
Mailing Address - Fax:
Practice Address - Street 1:2039 ADAMS RD
Practice Address - Street 2:
Practice Address - City:EAST GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:18041-2330
Practice Address - Country:US
Practice Address - Phone:215-527-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006477L174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist