Provider Demographics
NPI:1821547241
Name:BUTLER, PETER (OT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2913
Mailing Address - Country:US
Mailing Address - Phone:401-722-1311
Mailing Address - Fax:401-722-2246
Practice Address - Street 1:461 MAIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2913
Practice Address - Country:US
Practice Address - Phone:401-722-1311
Practice Address - Fax:401-722-2246
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01586225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist