Individual
IRENE BUTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
471 W TERRA COTTA AVE, CRYSTAL LAKE, IL 60014-3434
(815) 455-0550
Mailing address
471 W TERRA COTTA AVE, CRYSTAL LAKE, IL 60014-3434
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004114
IL
Other
Enumeration date
01/13/2017
Last updated
01/13/2017
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