MEDICARE: BRANDY BUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1285045229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY BUTLER

Provider Business Mailing Address
First Line	:	521 NW 90TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-3021
Country	:	US
Telephone Number	:	405-889-0512
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 NW 90TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-3021
Country	:	US
Telephone Number	:	405-889-0512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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Directions to “ BRANDY BUTLER ” Practice Location

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