Provider Demographics
NPI:1679059018
Name:BUTLER, MAGGIE (ATC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:BUTLER
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 1:700 GLOUCESTER DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3318
Mailing Address - Country:US
Mailing Address - Phone:331-202-9082
Mailing Address - Fax:
Practice Address - Street 1:401 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1229
Practice Address - Country:US
Practice Address - Phone:333-202-9082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL096.002909OtherNON-MEDICARE