Individual
MS. MARY K. BUTLAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
231 WALTON ST STE 200, SYRACUSE, NY 13202-1887
(315) 478-0380
Mailing address
219 E WILLIAMS ST, WATERLOO, NY 13165-1510
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002291-1
NY
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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