Healthcare Provider Details

I. General information

NPI: 1194179648
Provider Name (Legal Business Name): ASHLEY BUTCHER CFTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S PIKE ST
SHINNSTON WV
26431-1125
US

IV. Provider business mailing address

409 S PIKE ST
SHINNSTON WV
26431-1125
US

V. Phone/Fax

Practice location:
  • Phone: 304-592-1870
  • Fax: 304-371-3502
Mailing address:
  • Phone: 304-592-1870
  • Fax: 304-371-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCFTS1828
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFTS1828
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: