Provider Demographics
NPI:1740577972
Name:BUTLER, TIFFANY MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MARIE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-3600
Mailing Address - Country:US
Mailing Address - Phone:518-810-1615
Mailing Address - Fax:
Practice Address - Street 1:37 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-3600
Practice Address - Country:US
Practice Address - Phone:518-810-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018971225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist