Provider Demographics
NPI:1679848774
Name:BUTLER, LATOYA DIANE (MA60253910)
Entity Type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:DIANE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA60253910
Other - Prefix:
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Mailing Address - Street 1:4720 MILL POND DR SE
Mailing Address - Street 2:510
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3803
Mailing Address - Country:US
Mailing Address - Phone:253-792-0710
Mailing Address - Fax:
Practice Address - Street 1:4720 MILL POND DR SE
Practice Address - Street 2:510
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-3803
Practice Address - Country:US
Practice Address - Phone:253-792-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60253910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist