Individual
JACQUELINE BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2092 OMEGA RD STE G, SAN RAMON, CA 94583-1230
(415) 637-7616
Mailing address
2092 OMEGA RD STE G, SAN RAMON, CA 94583-1230
(415) 637-7616
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
3486
CA
2355S0801X
Speech-Language Assistant
2413
CA
252Y00000X
Early Intervention Provider Agency
Primary
240169349
CA
Other
Enumeration date
07/19/2016
Last updated
11/12/2024
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