Provider Demographics
NPI:1245998640
Name:BUCK, MEIRA CHARLEE (OTR/L)
Entity type:Individual
Prefix:
First Name:MEIRA
Middle Name:CHARLEE
Last Name:BUCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5158 MINA CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7867
Mailing Address - Country:US
Mailing Address - Phone:802-323-7109
Mailing Address - Fax:
Practice Address - Street 1:9470 CORKSCREW PALMS CIR STE 104
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3305
Practice Address - Country:US
Practice Address - Phone:802-323-7109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4178225XP0200X
FLOT23356225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116144300Medicaid