Provider Demographics
NPI:1649489220
Name:BRUCKER, JOANN GREEN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:GREEN
Last Name:BRUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:GREEN
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4066
Mailing Address - Country:US
Mailing Address - Phone:724-776-9941
Mailing Address - Fax:
Practice Address - Street 1:5827 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9404
Practice Address - Country:US
Practice Address - Phone:724-443-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist