Provider Demographics
NPI:1568750271
Name:BUTLER, KELLY BROOKE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:BROOKE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 LEE JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24440-1705
Mailing Address - Country:US
Mailing Address - Phone:540-337-2745
Mailing Address - Fax:
Practice Address - Street 1:3940 LEE JACKSON HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:VA
Practice Address - Zip Code:24440-1705
Practice Address - Country:US
Practice Address - Phone:540-337-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000014224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant