Provider Demographics
NPI:1477828283
Name:BUTLER, THEOLAR
Entity Type:Individual
Prefix:MRS
First Name:THEOLAR
Middle Name:
Last Name:BUTLER
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 1:6503 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-2108
Mailing Address - Country:US
Mailing Address - Phone:281-449-7685
Mailing Address - Fax:281-449-7685
Practice Address - Street 1:6503 HARMON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-2108
Practice Address - Country:US
Practice Address - Phone:281-449-7685
Practice Address - Fax:281-449-7685
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant