Provider Demographics
NPI:1497505754
Name:BUTCHER, TAMARRA MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:TAMARRA
Middle Name:MICHELLE
Last Name:BUTCHER
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 1:213 GROSS ST # A
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:MO
Mailing Address - Zip Code:64762-9511
Mailing Address - Country:US
Mailing Address - Phone:417-667-1071
Mailing Address - Fax:
Practice Address - Street 1:213 GROSS ST # A
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:MO
Practice Address - Zip Code:64762-9511
Practice Address - Country:US
Practice Address - Phone:417-667-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant