Provider Demographics
NPI:1811344849
Name:BUTTERFIELD, ALEXANDRA DAWN (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DAWN
Last Name:BUTTERFIELD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:WYLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3209 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-6889
Mailing Address - Country:US
Mailing Address - Phone:952-797-3009
Mailing Address - Fax:
Practice Address - Street 1:3209 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-6889
Practice Address - Country:US
Practice Address - Phone:952-797-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105057225X00000X
WI5980-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist