Provider Demographics
NPI:1184277477
Name:BRUCKMAN, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BRUCKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 STARMONT CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9565
Mailing Address - Country:US
Mailing Address - Phone:317-797-0642
Mailing Address - Fax:
Practice Address - Street 1:1335 DUBLIN RD STE 200B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7094
Practice Address - Country:US
Practice Address - Phone:614-595-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics