Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1053995985 |
---|---|
Provider Name | Jessica Butchee |
First Address | Moore, OK 73160-9046 |
Second Address | Moore, OK 73160-9046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2021 |
Last Update Date | 06/05/2021 |