Individual
JEFFREY BUCKNAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7711 GINGERWOOD DR, TRAVERSE CITY, MI 49685-9024
(231) 715-6122
Mailing address
7711 GINGERWOOD DR, TRAVERSE CITY, MI 49685-9024
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201005105
MI
Other
Enumeration date
11/04/2013
Last updated
11/04/2013
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