Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | CFTS1828 | WV |
NPI | 1194179648 |
---|---|
Provider Name | Ashley Butcher |
First Address | Shinnston, WV 26431-1125 |
Second Address | Shinnston, WV 26431-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2016 |
Last Update Date | 21/04/2016 |