Healthcare Provider Details

I. General information

NPI: 1043155377
Provider Name (Legal Business Name): EMMA ELAINE BUTLER CM II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S MUSKOGEE AVE
TAHLEQUAH OK
74464-4717
US

IV. Provider business mailing address

21893 S JULES VALDEZ RD
TAHLEQUAH OK
74464-8032
US

V. Phone/Fax

Practice location:
  • Phone: 918-207-0078
  • Fax: 918-207-0558
Mailing address:
  • Phone: 918-457-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: