Provider Demographics
NPI:1871792499
Name:BUTLER, HEATHER DAWN (PTA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BELLE CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43310-9307
Mailing Address - Country:US
Mailing Address - Phone:937-935-0599
Mailing Address - Fax:
Practice Address - Street 1:109 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BELLE CENTER
Practice Address - State:OH
Practice Address - Zip Code:43310-9307
Practice Address - Country:US
Practice Address - Phone:937-935-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 172A00000X, 3747P1801X
OHPTA 02282225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant