Provider Demographics
NPI:1306697511
Name:BUTTERFLY PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:BUTTERFLY PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:DANELLE
Authorized Official - Last Name:COCHO-TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:803-804-0879
Mailing Address - Street 1:814 WOODBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-7738
Mailing Address - Country:US
Mailing Address - Phone:803-804-0879
Mailing Address - Fax:
Practice Address - Street 1:814 WOODBRIDGE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-7738
Practice Address - Country:US
Practice Address - Phone:803-804-0879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty