Basic Information
| Provider Information | |||||||||
| NPI: | 1902142581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCHANAN | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 BLUE ST | ||||||||
| Address2: | |||||||||
| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993542209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099436871 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1745 PIKE AVE | ||||||||
| Address2: | |||||||||
| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993542295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099468095 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2012 | ||||||||
| LastUpdateDate: | 12/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT00002804 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | OT00002804 | 01 | WA | OT LICENSE | OTHER |