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Individual

DAVIANA BUTLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
49881 GRAND RIVER AVE, WIXOM, MI 48393-3309
(248) 229-4016
Mailing address
49881 GRAND RIVER AVE, WIXOM, MI 48393-3309

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
210407

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
210407
ATHLETIC CERTIFICATION & TRAINING COMMISSION
Enumeration date
06/02/2017
Last updated
06/02/2017
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