Provider Demographics
NPI:1538490990
Name:BUCKNER, LATANYA D (OT)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:D
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 EAST AVE
Mailing Address - Street 2:STE B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1909
Mailing Address - Country:US
Mailing Address - Phone:585-720-9608
Mailing Address - Fax:585-720-5484
Practice Address - Street 1:384 EAST AVE
Practice Address - Street 2:STE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1909
Practice Address - Country:US
Practice Address - Phone:585-720-9608
Practice Address - Fax:585-720-5484
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008247-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist