Provider Demographics
NPI:1851522056
Name:BUCK, WHITNEY BLANE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:BLANE
Last Name:BUCK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13099 NORTH STATE ROAD 61
Mailing Address - Street 2:
Mailing Address - City:LYNNVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47619
Mailing Address - Country:US
Mailing Address - Phone:812-483-1199
Mailing Address - Fax:866-785-4924
Practice Address - Street 1:1712 N LELAND DR
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9348
Practice Address - Country:US
Practice Address - Phone:812-683-2956
Practice Address - Fax:812-683-2413
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001712A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant