Provider Demographics
NPI:1942723515
Name:SOUTHERLAND, VICTORIA BUCK (OTR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:BUCK
Last Name:SOUTHERLAND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 E BARDEN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5831
Mailing Address - Country:US
Mailing Address - Phone:704-708-8314
Mailing Address - Fax:704-708-8315
Practice Address - Street 1:1505 E BARDEN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5831
Practice Address - Country:US
Practice Address - Phone:443-564-7275
Practice Address - Fax:704-708-8315
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10586225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist