MEDICARE: BETHANY DAWN BUTCHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1245829597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY DAWN BUTCHER

Provider Business Mailing Address
First Line	:	942 N BENNER HILL RD
Second Line	:
City	:	SOUTH SALEM
State	:	OH
Zip	:	45681-9777
Country	:	US
Telephone Number	:	740-626-2646
Fax Number	:

Provider Business Practice Location Address
First Line	:	942 N BENNER HILL RD
Second Line	:
City	:	SOUTH SALEM
State	:	OH
Zip	:	45681-9777
Country	:	US
Telephone Number	:	740-626-2646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	11/21/2022

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