MEDICARE: KIMBERLY BUTLER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician
3	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1770259996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BUTLER

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD STE 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	844-854-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	9440 MARLBORO PIKE
Second Line	:	SUITE 100
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2077
Country	:	US
Telephone Number	:	844-244-1818
Fax Number	:

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

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	08/18/2021

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Directions to “ KIMBERLY BUTLER ” Practice Location

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