Provider Demographics
NPI:1952560773
Name:BUTLER, ANTHONY (OTR)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29256 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4242
Mailing Address - Country:US
Mailing Address - Phone:586-751-6667
Mailing Address - Fax:586-751-1888
Practice Address - Street 1:29256 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4242
Practice Address - Country:US
Practice Address - Phone:586-751-6667
Practice Address - Fax:586-751-1888
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist