Provider Demographics
NPI:1275797300
Name:BUTTS, GLENDIA DIANE (MSOTR)
Entity Type:Individual
Prefix:MRS
First Name:GLENDIA
Middle Name:DIANE
Last Name:BUTTS
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-7013
Mailing Address - Country:US
Mailing Address - Phone:317-297-5956
Mailing Address - Fax:317-297-5956
Practice Address - Street 1:3644 WEST 48TH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228
Practice Address - Country:US
Practice Address - Phone:317-297-5956
Practice Address - Fax:317-297-5956
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000452A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist