Provider Demographics
NPI:1467736371
Name:BUKATY, SHANNON M (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:BUKATY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RED CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-4407
Mailing Address - Country:US
Mailing Address - Phone:716-656-1469
Mailing Address - Fax:
Practice Address - Street 1:9 RED CLOVER LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-4407
Practice Address - Country:US
Practice Address - Phone:716-656-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant