Provider Demographics
NPI:1477863413
Name:BUTT, PATRICIA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:BUTT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CLEVELAND PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6328
Mailing Address - Country:US
Mailing Address - Phone:516-798-7126
Mailing Address - Fax:516-797-6505
Practice Address - Street 1:115 CLEVELAND PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6328
Practice Address - Country:US
Practice Address - Phone:516-798-7126
Practice Address - Fax:516-797-6505
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006465224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant