Individual
DIANE L BUCKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
80 1ST ST, PRAIRIE DU SAC, WI 53578-1550
(608) 643-7263
(608) 643-7667
Mailing address
N2699 WILSON RD, POYNETTE, WI 53955-9564
(608) 643-7263
(608) 643-7667
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
288027
WI
Other
Enumeration date
01/15/2007
Last updated
07/08/2007
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