Provider Demographics
NPI:1265251029
Name:BUTCHER, PAMELA SUE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 WV HIGHWAY 47 W
Mailing Address - Street 2:
Mailing Address - City:COXS MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26342-8115
Mailing Address - Country:US
Mailing Address - Phone:304-804-2185
Mailing Address - Fax:
Practice Address - Street 1:4485 WV HIGHWAY 47 W
Practice Address - Street 2:
Practice Address - City:COXS MILLS
Practice Address - State:WV
Practice Address - Zip Code:26342-8115
Practice Address - Country:US
Practice Address - Phone:304-804-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency