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NPI Code Detail

MEDICARE: TANYA MICHELLE BUTCHER ATC

MEDICARE: TANYA MICHELLE BUTCHER ATC
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
12255A2300XAthletic Trainer118542MO

General Provider Information

NPI Number : 1972532000
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA MICHELLE BUTCHER ATC
Provider Business Mailing Address
First Line : 12250 NW MEADOWLANDS DR
Second Line :
City : PLATTE CITY
State : MO
Zip : 64079-7304
Country : US
Telephone Number : 816-858-0249
Fax Number :
Provider Business Practice Location Address
First Line : 1931 BURLINGTON ST
Second Line :
City : NORTH KANSAS CITY
State : MO
Zip : 64116-3407
Country : US
Telephone Number : 816-241-2131
Fax Number : 816-241-0551
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 07/08/2007

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Directions to “ TANYA MICHELLE BUTCHER ATC” Practice Location

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