Provider Demographics
NPI:1679274823
Name:BUTLER, ABIGAIL (COTA/L)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
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 1:224 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-2225
Mailing Address - Country:US
Mailing Address - Phone:731-819-0920
Mailing Address - Fax:
Practice Address - Street 1:1105 S SUNSWEPT ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-4370
Practice Address - Country:US
Practice Address - Phone:731-885-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003235224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant