Provider Demographics
NPI:1134700644
Name:BUCKLEY, ERIN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-2014
Mailing Address - Country:US
Mailing Address - Phone:585-643-0471
Mailing Address - Fax:
Practice Address - Street 1:624 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-2014
Practice Address - Country:US
Practice Address - Phone:585-643-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017006225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics