Individual
JACOB LARRY BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3337
(801) 357-7850
Mailing address
3613 E GOLDEN EAGLE RD, EAGLE MOUNTAIN, UT 84005-3866
(435) 650-7021
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
225X00000X
Occupational Therapist
Primary
11351103-4201
UT
Other
Enumeration date
10/23/2014
Last updated
11/08/2021
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