Provider Demographics
NPI:1487252078
Name:BUCCIARELLI, LIANA
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:BUCCIARELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 RABBITS FOOT TRL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3729
Mailing Address - Country:US
Mailing Address - Phone:585-694-9150
Mailing Address - Fax:
Practice Address - Street 1:195 BERRYMAN RD
Practice Address - Street 2:
Practice Address - City:FRENCHBURG
Practice Address - State:KY
Practice Address - Zip Code:40322-8496
Practice Address - Country:US
Practice Address - Phone:606-768-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist