MEDICARE: MIKAILY BUTCHKO MOT

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	225XP0200X	Pediatric Occupational Therapist	OT25683	FL

General Provider Information

NPI Number	:	1538981436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAILY BUTCHKO MOT

Provider Business Mailing Address
First Line	:	9637 RIVERCHASE DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-5724
Country	:	US
Telephone Number	:	727-207-8185
Fax Number	:

Provider Business Practice Location Address
First Line	:	9637 RIVERCHASE DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-5724
Country	:	US
Telephone Number	:	727-207-8185
Fax Number	:

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

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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Directions to “ MIKAILY BUTCHKO MOT” Practice Location

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