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Individual
BRENNA BUCKNER
Active
Individual
BRENNA BUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.011487
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056.011487
STATE OF ILLINOIS
IL
Enumeration date
03/30/2016
Last updated
03/30/2016
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