Provider Demographics
NPI:1851566368
Name:OWEN BUCKLEY, PATRICIA ROSE (MAC, LAC, DIPLOMA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ROSE
Last Name:OWEN BUCKLEY
Suffix:
Gender:F
Credentials:MAC, LAC, DIPLOMA
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ROSE
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9176 WINFLOWER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:443-745-4228
Mailing Address - Fax:
Practice Address - Street 1:8821 COLUMBIA 100 PARKWAY
Practice Address - Street 2:SUITE 5
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:443-745-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01264171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist