Provider Demographics
NPI:1275895161
Name:BUTLER, CASSANDRA JOAN
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:JOAN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:JOAN
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:43 MONROE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6827
Mailing Address - Country:US
Mailing Address - Phone:716-632-1004
Mailing Address - Fax:
Practice Address - Street 1:1641 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2905
Practice Address - Country:US
Practice Address - Phone:716-835-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007815-1173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist