Provider Demographics
NPI:1205571254
Name:BUYCK, PATRICIA MARIE (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:MARIE
Last Name:BUYCK
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 1:6928 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-9349
Mailing Address - Country:US
Mailing Address - Phone:315-576-5048
Mailing Address - Fax:
Practice Address - Street 1:6928 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9349
Practice Address - Country:US
Practice Address - Phone:315-576-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist