Provider Demographics
NPI:1235727660
Name:BUTT, MOLLY JO
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:JO
Last Name:BUTT
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 1:205 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9359
Mailing Address - Country:US
Mailing Address - Phone:740-364-8290
Mailing Address - Fax:
Practice Address - Street 1:205 KNOLL DR
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9359
Practice Address - Country:US
Practice Address - Phone:740-364-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker