Provider Demographics
NPI:1366644783
Name:BUTIKOFER, MARJORIE LISA (OTR)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:LISA
Last Name:BUTIKOFER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-8719
Mailing Address - Country:US
Mailing Address - Phone:918-478-4480
Mailing Address - Fax:918-478-4480
Practice Address - Street 1:418 S EAST ST
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434-8719
Practice Address - Country:US
Practice Address - Phone:918-478-4480
Practice Address - Fax:918-478-4480
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist