Provider Demographics
NPI:1184496853
Name:BUTLER, KAI
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PRIVATE DRIVE 140
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-8216
Mailing Address - Country:US
Mailing Address - Phone:240-803-8616
Mailing Address - Fax:
Practice Address - Street 1:52 PRIVATE DRIVE 140
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8216
Practice Address - Country:US
Practice Address - Phone:240-803-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker