Provider Demographics
NPI:1306513536
Name:BUTTS, DENNIECE MARQUIS
Entity type:Individual
Prefix:
First Name:DENNIECE
Middle Name:MARQUIS
Last Name:BUTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 APPIA WAY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-8022
Mailing Address - Country:US
Mailing Address - Phone:678-920-1557
Mailing Address - Fax:
Practice Address - Street 1:15 APPIA WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-8022
Practice Address - Country:US
Practice Address - Phone:678-920-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT007786OtherOCCUPATIONAL THERAPIST