MEDICARE: TERRI 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	3245S0500X	Children's Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1821382318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI BUTCHER

Provider Business Mailing Address
First Line	:	66 NORTH 180 WEST
Second Line	:
City	:	EPHRIAM
State	:	UT
Zip	:	84627-1111
Country	:	US
Telephone Number	:	435-283-0164
Fax Number	:	435-283-2213

Provider Business Practice Location Address
First Line	:	66 NORTH 180 WEST
Second Line	:
City	:	EPHRIAM
State	:	UT
Zip	:	84627-1111
Country	:	US
Telephone Number	:	435-283-0164
Fax Number	:	435-283-2213

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

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	06/02/2011

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Directions to “ TERRI BUTCHER ” Practice Location

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