Provider Demographics
NPI:1043524143
Name:BUTCHER, CONNIE CANTRELL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:CANTRELL
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14318 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-8603
Mailing Address - Country:US
Mailing Address - Phone:440-821-0974
Mailing Address - Fax:440-638-4339
Practice Address - Street 1:14318 BOSTON RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-8603
Practice Address - Country:US
Practice Address - Phone:440-821-0974
Practice Address - Fax:440-638-4339
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT004200225X00000X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics