Provider Demographics
NPI:1447935754
Name:HORNBUCKLE, OLIVER
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:HORNBUCKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 NEW RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-4153
Mailing Address - Country:US
Mailing Address - Phone:678-458-6793
Mailing Address - Fax:
Practice Address - Street 1:524 NEW RIVER WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-4153
Practice Address - Country:US
Practice Address - Phone:678-458-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist