=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912270703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS ANNA KRISTINE BUTTWEILER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2012
-----------------------------------------------------
Last Update Date | 02/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2708 NE 14TH ST SUITE 5
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-3565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-880-9270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30195 OLINDA TRL
-----------------------------------------------------
City | LINDSTROM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55045-9418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-249-5112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Q00000X
-----------------------------------------------------
Taxonomy Name | Developmental Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------