Individual
KIM MICHELLE BUCKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2440 GOLD STAR HWY, SUITE 201, MYSTIC, CT 06355-1180
(860) 536-1001
Mailing address
18 UPPER KENSINGTON DR, EAST LYME, CT 06333-1164
(860) 451-8623
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
001892
CT
261QP2000X
Physical Therapy Clinic/Center
001892
CT
Other
Enumeration date
09/13/2012
Last updated
10/21/2022
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