Provider Demographics
NPI:1699053199
Name:BUCKMASTER, THERESA J (BSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:BUCKMASTER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:J
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:405 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-4611
Mailing Address - Country:US
Mailing Address - Phone:918-360-3958
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 131C
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-9223
Practice Address - Country:US
Practice Address - Phone:918-452-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator