Provider Demographics
NPI:1437320827
Name:BUCHANAN, KAMAL (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:M
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 1:3024 AVENUE V APT 5F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5437
Mailing Address - Country:US
Mailing Address - Phone:347-409-0947
Mailing Address - Fax:
Practice Address - Street 1:3024 AVENUE V APT 5F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5437
Practice Address - Country:US
Practice Address - Phone:347-409-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist