=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811536790
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHEL BUTLER AP. DIPL.O.M
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2019
-----------------------------------------------------
Last Update Date | 01/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 10TH AVE N STE B
-----------------------------------------------------
City | JACKSONVILLE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32250-4798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-910-8046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 10TH AVE N STE B
-----------------------------------------------------
City | JACKSONVILLE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32250-4798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-910-8046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 4123
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------