Provider Demographics
NPI:1518568526
Name:BUTTERS, JORDAN KANDRA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:KANDRA
Last Name:BUTTERS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1703
Mailing Address - Country:US
Mailing Address - Phone:570-404-5154
Mailing Address - Fax:
Practice Address - Street 1:11 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1703
Practice Address - Country:US
Practice Address - Phone:570-404-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025171225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist