Provider Demographics
NPI:1265683536
Name:BUCHANAN, JAMIE LEE (MOT, LOTR)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 US 1 S
Mailing Address - Street 2:SUITE N
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6341
Mailing Address - Country:US
Mailing Address - Phone:904-540-9595
Mailing Address - Fax:
Practice Address - Street 1:2730 US 1 S
Practice Address - Street 2:SUITE N
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6341
Practice Address - Country:US
Practice Address - Phone:904-540-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200363225XP0200X
FLOT13349225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics