Provider Demographics
NPI:1902114093
Name:BUCKLEY, ROSEMARIE (MA OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PLITT AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5109
Mailing Address - Country:US
Mailing Address - Phone:516-753-0403
Mailing Address - Fax:516-843-0181
Practice Address - Street 1:146 PLITT AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5109
Practice Address - Country:US
Practice Address - Phone:516-753-0403
Practice Address - Fax:516-843-0181
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012008-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist