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NPI Code Detail

MEDICARE: WANDA FAYE BUTLER M.ED

MEDICARE:   WANDA FAYE BUTLER  M.ED
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
1174400000XSpecialist
2235500000XSpeech/Language/Hearing Specialist/Technologist
3310400000XAssisted Living Facility
4311500000XAlzheimer Center (Dementia Center)
5311Z00000XCustodial Care Facility
6311ZA0620XAdult Care Home Facility
7314000000XSkilled Nursing Facility
8320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility
9320800000XMental Illness Community Based Residential Treatment Facility
10390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1801173406
Entity Type Code : Individual
Provider Name (Legal Business Name) : WANDA FAYE BUTLER M.ED
Provider Business Mailing Address
First Line : 3083 SILVER CEDAR TRL
Second Line :
City : KATY
State : TX
Zip : 77449-6280
Country : US
Telephone Number : 832-512-3863
Fax Number : 281-331-0453
Provider Business Practice Location Address
First Line : 2220 COUNTY ROAD 144
Second Line :
City : ALVIN
State : TX
Zip : 77511-7847
Country : US
Telephone Number : 832-512-3863
Fax Number : 281-331-0453
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2011
Last Update Date : 11/10/2011

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