Provider Demographics
NPI:1972532000
Name:BUTCHER, TANYA MICHELLE (ATC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MICHELLE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12250 NW MEADOWLANDS DR
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7304
Mailing Address - Country:US
Mailing Address - Phone:816-858-0249
Mailing Address - Fax:
Practice Address - Street 1:1931 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3407
Practice Address - Country:US
Practice Address - Phone:816-241-2131
Practice Address - Fax:816-241-0551
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1185422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer