Provider Demographics
NPI:1306021688
Name:BUTLER-LEE, KATHLEEN LOUISE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:BUTLER-LEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 SW 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-3606
Mailing Address - Country:US
Mailing Address - Phone:954-724-8074
Mailing Address - Fax:
Practice Address - Street 1:1229 SW 74TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-3606
Practice Address - Country:US
Practice Address - Phone:954-724-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA21333225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist