Individual
LISA BUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3324 GREEN LAKE DR UNIT 1, FORT COLLINS, CO 80524-8850
(970) 481-6340
Mailing address
3324 GREEN LAKE DR UNIT 1, FORT COLLINS, CO 80524-8850
(970) 481-6340
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT.0001228
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123776400
—
WY
05
—
48232777
—
CO
01
—
P00762469
RR MEDICARE
CO
Enumeration date
10/17/2006
Last updated
10/19/2020
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