Provider Demographics
NPI:1194246785
Name:BUTLER, KAYLEEN ELIZABETH (LMT)
Entity type:Individual
Prefix:MRS
First Name:KAYLEEN
Middle Name:ELIZABETH
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CEMETERY ST
Mailing Address - Street 2:
Mailing Address - City:PINE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14872-9723
Mailing Address - Country:US
Mailing Address - Phone:607-301-0985
Mailing Address - Fax:
Practice Address - Street 1:83 W PULTENEY ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2213
Practice Address - Country:US
Practice Address - Phone:607-301-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist