Healthcare Provider Details

I. General information

NPI: 1508453952
Provider Name (Legal Business Name): TARA BUTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1562 TROUT RD
WILLIAMSBURG WV
24991-3216
US

IV. Provider business mailing address

302 BUTCHER LN
CRAWLEY WV
24931-7032
US

V. Phone/Fax

Practice location:
  • Phone: 304-667-0728
  • Fax:
Mailing address:
  • Phone: 304-667-9673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: