Provider Demographics
NPI:1093040164
Name:MARYANN BUTCHKO OT PLLC
Entity Type:Organization
Organization Name:MARYANN BUTCHKO OT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCHKO
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:828-242-4410
Mailing Address - Street 1:200 ASHELAND AVE
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4016
Mailing Address - Country:US
Mailing Address - Phone:828-242-4410
Mailing Address - Fax:
Practice Address - Street 1:200 ASHELAND AVE
Practice Address - Street 2:SUITE 200B
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4016
Practice Address - Country:US
Practice Address - Phone:828-242-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5436225XP0200X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137X9OtherBC/BS
NC2510860AMedicare PIN