NPI 1972908762 · live from the CMS NPI Registry
Jacob Larry Butler
Occupational Therapist in Provo, UT. National Provider Identifier 1972908762, active.
NPI record
| NPI | 1972908762 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Occupational Therapist 225X00000X |
| Practice location | 1034 N 500 W, Provo, UT 84604 |
| Practice phone | 801-357-7850 |
| Mailing address | 3613 E Golden Eagle Rd, Eagle Mountain, UT 84005 |
| Enumerated | October 23, 2014 |
| Last updated | November 8, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor | 101Y00000X | — |
| Occupational Therapist primary | 225X00000X | 11351103-4201 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.