Provider Demographics
NPI:1780841494
Name:BUTLER, QIANA (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:QIANA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9624 S CICERO AVE # 144
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3138
Mailing Address - Country:US
Mailing Address - Phone:708-299-8486
Mailing Address - Fax:
Practice Address - Street 1:8326 S LA SALLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-1226
Practice Address - Country:US
Practice Address - Phone:773-723-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist