Provider Demographics
NPI:1871338426
Name:BUTLER, ASHLEY DAWN (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-0054
Mailing Address - Country:US
Mailing Address - Phone:918-272-9919
Mailing Address - Fax:
Practice Address - Street 1:435 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3208
Practice Address - Country:US
Practice Address - Phone:918-272-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK156713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist