Provider Demographics
NPI:1386004596
Name:BUCKMAN, NICOLE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BUCKMAN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ROBIN
Other - Last Name:MONTALTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:2823 YOST RD
Mailing Address - Street 2:
Mailing Address - City:PERKIOMENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18074-9342
Mailing Address - Country:US
Mailing Address - Phone:610-888-6350
Mailing Address - Fax:
Practice Address - Street 1:2823 YOST RD
Practice Address - Street 2:
Practice Address - City:PERKIOMENVILLE
Practice Address - State:PA
Practice Address - Zip Code:18074-9342
Practice Address - Country:US
Practice Address - Phone:610-888-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011032225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation