MEDICARE: TARA 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	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7571	OTHER		NO INSURER

General Provider Information

NPI Number	:	1508453952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA BUTCHER

Provider Business Mailing Address
First Line	:	302 BUTCHER LN
Second Line	:
City	:	CRAWLEY
State	:	WV
Zip	:	24931-7032
Country	:	US
Telephone Number	:	304-667-9673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1562 TROUT RD
Second Line	:
City	:	WILLIAMSBURG
State	:	WV
Zip	:	24991-3216
Country	:	US
Telephone Number	:	304-667-0728
Fax Number	:

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

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “ TARA BUTCHER ” Practice Location

Language	Start Address	Practice Location

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