Buck Jack LLC

NPI #1912505116 in Pueblo, Colorado

Provider Information

NPI Number: 1912505116
Entity Type: Organization
Organization Name: Buck Jack LLC
Primary Specialty: Occupational Therapist
Enumeration Date: Oct 12, 2020
Last Updated: Oct 12, 2020

Practice Location

Address: 1301 FORTINO BLVD
City: Pueblo
State: Colorado
ZIP Code: 81008-2032
Phone: (719) 597-0822

Authorized Official

Name: REBECCA NEWMAN
Title: BILLING MANAGER
Phone: (719) 597-0822

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Analyst	103K00000X
Psychologist	103T00000X
Physical Therapist	225100000X
Speech-Language Pathologist	235Z00000X
Occupational Therapist	225X00000X	Primary

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