Provider Demographics
NPI:1710291836
Name:BUTLER, SHAWNA SUE
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:SUE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:SUE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2139 RAINBOWER CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-8261
Mailing Address - Country:US
Mailing Address - Phone:863-581-5000
Mailing Address - Fax:863-686-0981
Practice Address - Street 1:1021 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4672
Practice Address - Country:US
Practice Address - Phone:863-686-1221
Practice Address - Fax:863-686-0981
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist