Provider Demographics
NPI:1124213210
Name:BUCKNER, SARA LYNN (NATIONALLY CERTIFIED)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:NATIONALLY CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2571
Mailing Address - Country:US
Mailing Address - Phone:508-285-1970
Mailing Address - Fax:508-285-1972
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2571
Practice Address - Country:US
Practice Address - Phone:508-285-1970
Practice Address - Fax:508-285-1972
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA517309-06225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist