Individual
JESSE BUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
834 S FRONT ST, MEDFORD, OR 97502-2726
(541) 664-7400
Mailing address
560 NE F ST STE A, #114, GRANTS PASS, OR 97526
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
04/04/2020
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